tecnicas de sutura - kantor

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    AT LA S o f   

    SUTURING TECHNIQUES

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    NOTICE

    Medicine is an ever-changing science. As new research and clinical experience

     broaden our know ledge, changes in treatm ent and drug th erapy are required.

    The auth or and the publisher o this work have checked with sources believed

    to be reliable in their e orts to provide in ormation that is complete and gener-

    ally in accord w ith the standards accepted at the time o publication. How ever,

    in view o the possibility o human error or changes in medical sciences, nei-

    ther the author nor the pub lisher nor any other party wh o has been involved

    in the preparation or publication o this work warrants that the in ormation

    contained herein is in every respect accurate or complete, and they disclaim

    all responsibility or any errors or omissions or or the results obtained rom

    use o the in ormation contained in this w ork. Readers are encouraged to con-

      rm the in ormation contained herein w ith other sources. For example and in

     particu lar, readers are advised to check the product in ormation sheet included

    in the package o each drug they p lan to adm inister to be certain that th e

    in ormation contained in this work is accurate and that changes have not beenmade in the recommended dose or in the contraindications or administration.

    This recommendation is o particular importance in connection w ith new or

    in requently used drugs.

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     New York Chicago San Francisco Athens London Madrid Mexico City

    Milan New Delhi Singapore Sydney Toronto

    Jonathan Kantor, MD, MSCE, MA Adjunct Assistant Professor of Dermatology

    Perelman School of Medicine

    University of Pennsylvania

    Philadelphia, Pennsylvania

    Medical Director 

    Florida Center for Dermatology, PA

    St. Augustine, Florida

    Approaches to Surgical Wound,

    Laceration, and Cosmetic Repair 

    ATLAS o f   

    SUTURINGTECHNIQUES

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    Copyright © 2016 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States

    Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or

    stored in a database or retrieval system, without the prior written permission of the publisher, with the exception that

    the program listings may be entered, stored, and executed in a computer system, but they may not be reproduced for

     publication.

    ISBN: 978-0-07-183658-6

    MHID: 0-07-183658-6

    The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-183657-9,

    MHID: 0-07-183657-8.

    eBook conversion by codeMantra

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    To my parents, or pushing and believing rom the very beginning.

    To my kids, or giving me the time, patience, inspiration, and love that was needed

    to see this project—and myriad oth ers—through to completion.

    And to Bella, my passionate partner in love and li e, or making it all possible.

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    vii

    CONTENTS

    Foreword xi

    Preface xiii

    Acknowledgments xv

     4.1. The Simple Buried Dermal Suture 24

     4.2. The Set-Back Dermal Suture 27

     4.3. The Buried Vertical Mattress Suture 31

     4.4. The Buried Horizontal Mattress Suture 35

     4.5. The Butterf y Suture 38

     4.6. The Running Subcuticular Suture 42

     4.7. The Backing Out Running Subcuticular Suture 48

     4.8. The Percutaneous Vertical Mattress Suture 52

     4.9. The Percutaneous Set-Back Dermal Suture 56

     4.10. The Percutaneous Horizontal Mattress Suture 61

     4.11. The Running Buried Dermal Suture 65

     4.12. The Running Set-Back Dermal Suture 68

     4.13. The Running Buried Vertical Mattress Suture 72

     4.14. The Running Percutaneous Set-Back Dermal Suture 76

     4.15. The Running Percutaneous Buried Vertical Mattress Suture 81

     4.16. The Pulley Buried Dermal Suture 85

     4.17. The Pulley Set-Back Dermal Suture 89

     4.18. The Pulley Buried Vertical Mattress Suture 94

     4.19. The Hal Pulley Buried Vertica l Mattress Suture 99

     4.20. The Double Butterf y Suture 103

     4.21. The Hal Pulley Buried Dermal Suture 108

    CHAPTER 1

    CHAPTER 2

    INTRODUCTION 1

    THE SURGICAL TRAY 5

    CHAPTER 3

    CHAPTER 4

    SUTURE MATERIALS, KNOT TYING, AND

    POSTOPERATIVE CARE 11

    SUTURE TECHNIQUES FOR DEEPER STRUCTURES:

    THE FASCIA AND DERMIS 23

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    viii  CONTENTS

     4.22. The Suspension Suture 111

     4.23. The Percutaneous Suspension Suture 115

     4.24. The Tie-Over Suture 118

     4.25. The Buried Vertical Mattress Suspension Suture 121

     4.26. The Fasc ial Plication Suture 124

     4.27. The Corset Plication Suture 127

     4.28. The Imbrication Suture 131  4.29. The Guitar String Suture 134

     4.30. The Dog-Ear Tacking Suture 137

     4.31. The Buried Purse-String Suture 140

     4.32. The Percutaneous Purse-String Suture 144

     4.33. The Figure 8 Double Purse-String Suture 148

     4.34. The Stacked Double Purse-String Suture 152

     4.35. The Bootlace Suture 156

     4.36. The Buried Tip Stitch 160

     4.37. The Backtracking Running Butterf y Suture 163

     4.38. The Stacked Backing Out Subcuticular Suture 167  4.39. The Running Locked Intradermal Suture 171

     5.1. The Simple Interrupted Suture 176

     5.2. The Depth-Correcting Simple Interrupted Suture 179 5.3. The Simple Running Suture 182

     5.4. The Running Locking Suture 187

     5.5. The Horizontal Mattress Suture 192

     5.6. The Locking Horizontal Mattress Suture 196

     5.7. The Inverting Horizontal Mattress Suture 200

     5.8. The Running Horizontal Mattress Suture 203

     5.9. The Running Horizontal Mattress Suture with Intermittent Simple Loops 207

     5.10. The Running Alternating Simple and Horizontal Mattress Suture 212

     5.11. The Running