|
this short presentation is on suturing of wounds or defects that 这个简短的演示是关于伤口或缺损的缝合，这些伤口或缺损 have more than the conventional two sides to the wound this is how to suture 比传统的伤口有两个侧面 这是如何 a wound or a defect with three or more sides to it this becomes crucial 缝合伤口或有三个或更多侧面的缺损 when we move on to how to use local flaps 当我们继续讨论如何使用局部缝合时，这变得至关重要皮瓣 or that plasters to reconstruct defects in the head and neck or the face the key 或石膏以重建头部和颈部或面部的缺陷 to a successful outcome in these elaborate 在这些精心制作的 procedures is not just very good planning but also precise 程序中取得成功的关键不仅是非常好的计划，而且还需要精确 suturing of the tips of different flaps meeting at one 缝合不同皮瓣的尖端在一个点相遇， point when would we use a three-point junction suture 我们什么时候使用 三点连接缝合 we use it in situations like these when there is 我们在这些情况下使用它，当 a need for precise suturing of the tips of several angled flaps of skin 需要精确缝合几个成角度的皮瓣的尖端时 and commonly and when you are doing an endoplasty whether the conventional ，通常以及当您进行内成形 hemoplasty on a fusiform shaped wound or a defect 术时，无论是在梭形伤口上的传统血液成形术还是缺损 or when you are using it in combination with an esoplasty 或者当你将它与外成形术结合使用 when you're doing z plus this particularly multiple 时，当你在做 z 加上这个特别是 z blasters with several corners or when you're using a v 带有多个角的多个 z 冲击波时，或者当你在 y 中使用 v 时 into y advancement flap uh changing a v shaped defect into a white effect advancement flap uh将 v 形缺陷变成具有三点连接的白色效果 with a three point junction or when you are using local flaps ，或者当您使用局部皮瓣 local facial flaps either rotation or otherwise 局部面部皮瓣旋转或以其他 to fill up a defect and using a z velocity 方式填充缺陷并 at one of its end as well all these are examples of situations 在其一端使用 z 速度时，所有这些都是示例 when a three-point junction suture will be required the three point 需要三点 junction suture is different from the corner stitch we 接合缝合的情况 三点接合缝合不同于 use a corner stitch when you have a defect with two sides to it 角缝 当您的缺损有两侧时，我们使用角缝合其中一侧 one of them is angled with potentially reduced blood supply 是倾斜的，与 in contrast to the three-point junction suture 此相反，血液供应可能会减少 到三点连接缝合， when there are three or even more different flaps all meeting 当有三个或更多不同的皮瓣全部 at one point and the corner stitch which is basically a half 在一个点相遇时，角缝基本上是半 buried horizontal mattress you have your suture 埋水平床垫，你的缝合 material on the surface on the wider side of the wound and 材料在伤口较宽的一侧的表面上， deeper to the surface on the other angle side of the wound that's to avoid 更深 到伤口另一侧的表面，这是为了避免 compromising and already reduce blood supply 妥协，并且已经减少 to the tip of the ankle side 了脚踝一侧尖端的血液供应， so you bounce the suture through the skin on the wider 所以你会反弹 将缝合线穿过角侧较宽的一侧的皮肤， side on the angle side you avoid placing it on the skin you 避免将其放在皮肤上， pass through the deep dermis four to six millimeters from the tip 穿过真皮深处，距尖端四到六毫米， bring it back to the wider side and that's where you are going to tie 将其放回较宽的一侧，这就是您要系紧 the knot and this is basically a half-buried 的地方 结，这基本上是一个半掩埋的 horizontal mattress suture but you've avoided compromising the 水平褥式缝合线，但你已经避免 blood supply to the tip and placed it precisely to fit 损害尖端的血液供应，并将它精确地 on the other concave angle part of the skin on the other side 放置在三点连接缝合线另一侧皮肤的另一个凹角部分上 on the three-point junction suture on the other hand you would have to do 另一方面，你必须 the subcuticular dermal suture on the three flaps rather than just 在三个皮瓣上进行皮下真皮缝合，而不是 once like in the corner stitch and all of the three flaps you would 像角缝那样只缝合一次，所有三个皮瓣你都可以 pass your needle horizontally into the derm in the deeper part of the 将针水平地穿过真皮深层的 dermis on that side retrieve the needle and do it again 真皮 一侧取回针头并 on the other two sides a deep dermal suture you try to avoid passing 在其他两侧再次进行 深层真皮缝合 您尽量避免 close to the tip by about four millimeters 靠近针尖约四毫米 and you use an absorbable suture like a 400 or a 5 or monocle 并使用可吸收缝合线，如400 或 5 或 mon ocle or vicryl and once you've retrieved your needle finally 或 vicryl，一旦你取回针头，由于伤口的特殊 y 结构，你最终 you tie the knot in two directions because of the special y configuration 会在两个方向上打结 of the wound and then you have a bedded knot under ，然后你在表面下有一个层状结 the surface with good alignment of the three tips ，三个尖端很好地对齐 together without compromising their blood supply 在一起，而不会影响它们的血液 提供 this precise surgical technique will be crucial 这种精确的手术技术对于面部 in the reconstruction of complex wounds in the face 复杂伤口的重建 or in the use of several flaps including the m 或使用包括 m flab and the plasti either alone or combined with an flab 和 plasti 在内的多个皮瓣是至关重要的，无论是单独使用还是 esoplasty with the use of the v and y technique or with various 与使用 v 和y 技术或各种 z blasters particularly multiple z plus z blaster 特别是 multiple z plus |
|
|
