2. Suture: used for suturing tissues and ligating blood vessels. The thread used in the operation should meet the following conditions: it has certain tension, is easy to knot, has little tissue reaction, is non-toxic, non-allergenic, non-carcinogenic, and is easy to disinfect and store. Sutures can be divided into two categories: absorption lines and non-absorption lines.

(1) Absorbable sutures are mainly catgut and synthetic fibers.

① Intestinal line is made of submucosa of sheep small intestine. Because it is a heterogeneous protein, it will cause obvious tissue reaction in human body. Therefore, using too much and too thick catgut will aggravate the inflammatory reaction of the wound. There are two kinds of gut: ordinary gut and chrome gut. Ordinary catgut begins to be absorbed after about-weeks, and is mostly used for ligating and suturing skin. Chromium catgut begins to be absorbed after about 2-3 weeks and is used to suture deep tissues. The absorption rate of intestinal line is different in various tissues, and the absorption rate of peritoneum is the fastest, followed by muscle and subcutaneous tissue is the slowest. The number of gut lines can reflect the thickness of lines. The larger the positive number, the thicker the line, and the more "0", the thinner the line. Generally, the 4/0-2 catgut with a diameter of 0.02 ~ 0.6 mm and a difference of 0.08 mm between adjacent catgut lines can be used to suture tissues unsuitable for long-term foreign bodies to avoid induration and calculus, and can also be used to suture infected deep wounds. Clinically, catgut suture is mainly used to suture the mucosa of stomach, intestine, bladder, ureter, biliary tract and other organs. Generally speaking, catgut is made of 1-0 to 4-0 chromium. Thick (0 ~ 2) chrome catgut is often used to suture deep tissues or infected peritoneum. Using catgut in infected wounds can reduce sinus tracts that are difficult to heal due to other unabsorbed sutures.

Attention should be paid when using catgut: a, catgut is hard, so it should be soaked in salt water before use, and then used after it becomes soft, but it should not be soaked in hot water or for too long, so as to avoid the catgut from swelling and folding, which will affect the quality. B, you can't use needle forceps or vascular forceps to clamp the gut, and you can't twist the gut, which is easy to tear and break. C. Intestinal tubes are generally hard, thick and slippery, and triple knots are required for ligation. When cutting the thread, the thread end should be longer, otherwise the knot will fall off easily. Generally, continuous suture is used to avoid knotting too much, which will cause serious foreign body reaction after operation. D, pancreatic surgery, no catgut ligation or suture, because catgut can be digested and absorbed by the pancreas, resulting in secondary bleeding or anastomotic rupture. E, try to choose catgut. The price of catgut is more expensive than that of silk.

② synthetic fiber thread. With the progress of science and technology, more and more synthetic fiber threads are used in clinic. They are all high molecular polymers, and have the advantages of light tissue reaction, strong tension resistance, long absorption time and antibacterial effect. This kind of thread is elastic, so four or more knots are required. Dexon(PGA, polyglycolic acid) is commonly used, and its appearance is green and white, and it is a needle and thread made of multiple tightly woven strands; Thickness from 6-0 to 2, high tensile strength, not easy to break; Soft and smooth, easy to knot, good operation feel; Glycolic acid produced after hydrolysis has antibacterial effect and can be completely absorbed in 60 ~ 90 days. 3-0 series is suitable for gastrointestinal, urinary, ophthalmic and gynecological operations. L-ray is suitable for suture peritoneum, tendon sheath, etc. There are two kinds of Vicryl(Polyglactin 9 10): protective Vicho and rapid Vicho. Protecting Vicho has good clinical predictability and can provide strong wound support. It is characterized by complete absorption within 56-70 days through hydrolysis; The specification is as fine as possible, and the implanted material is less, so that the tissue around the suture has little reaction and no foreign body residue; The internal tensile strength is high, which can support the wound for 28~35 days; Convenient operation and knotting; The coated fiber eliminates the rough edge of the suture and has little resistance and damage to the tissue. Quick-maintenance bridge can provide short-term support for wounds and is the fastest-absorbed synthetic suture. It is characterized by the rapid disappearance of tensile strength 14 days after operation, the initial strength is similar to that of silk thread and gut line, and the tissue reaction is very small. The combined fillet has little damage to muscle and mucosa, and is especially suitable for suture of superficial skin and mucosa. In addition, Banjarmasin (polyethylene glycol carbonate) and PDS (poly-p-dioxanone, poly-p-dioxanone) have their own advantages.

(2) Do not absorb suture

There are dozens of kinds of mulberry silk thread, cotton thread, stainless steel thread, nylon thread, tantalum thread, silver thread and hemp thread. According to the different tensile strength and thickness of suture, it is also divided into different models. The greater the positive number, the thicker the suture and the greater the tensile strength. The more "0", the thinner the thread, and the number of the thinnest minimally invasive microsurgery suture is12 "0". 3-0.0, 4 and 7 are commonly used. 1 thread is used to suture skin, subcutaneous tissue and fascia; Thick silk thread is used for ligation of great vessels, tension-reducing suture and suture of peritoneum, ligament and tendon. The most commonly used silk thread in clinic has the advantages of small tissue reaction, soft texture, easy knotting, strong tension resistance, high temperature sterilization resistance, low price and easy source. The disadvantage is that it is a permanent foreign body in the tissue, and it is easy to form sinus after wound infection. Suture of biliary tract and urinary tract can cause stone formation. The use and tension resistance of cotton thread are not as good as that of silk thread, but the tissue reaction is light and the tension resistance is maintained for a long time, and the usage is the same as that of silk thread. Metal wire includes stainless steel wire and tantalum wire, which has simple sterilization, little stimulation and high tension resistance, but it is not easy to knot. It is often used for suture of bone, tendon and fascia, tension-reducing suture or tooth fixation in oral cavity. Nylon silk has little tissue reaction and can be made into very thin thread, which is mostly used for small blood vessel suture and plastic surgery. When it is used to suture small blood vessels, it is often made into a broken suture. Its disadvantage is that the knot is easy to loosen and break when the ligation is too tight, which is not suitable for deep tissue suture with tension.

With the progress of science and technology and medicine, it has been applied to various incision bonding materials to replace sutures and sutures. Its advantages are convenient and quick use, and small scar after wound healing. There are mainly surgical zippers, medical glue and metal nails.

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