PURSE-STRING SUTURING TECHNIQUE
The purse-string suture technique is a continuous stitch that is used as a bag constrict thread to close the entrance around a lumen. For example; it can be used to staple appendist root in the gut. The purse-string stitch is a simple technique that can be used to achieve minimal scarring and to reduce the surface area of circular wounds. This suture is placed before an ‘ostomy’ tube is inserted or can be used to reduce rectal prolapse or temporarily close the anal sphincter before rectum surgery. It can also be used to cover a hole in the thoracic wall after penetration into a foreign body (eg a rod). If the suture is placed after the tube is placed, the tube lumen may be disrupted. Placing a bag of mouth suture around the anal sphincter prevents the passage of feces that can contaminate the surgical site. A series of sutures are placed around the ostomy tube so that the suture needle comes to the point where it started. When this is pulled tight, it packs the tissues like a cloth bag. A long sewing material is left at both ends, which allows the suture to be pulled tightly and is used to tie the knot. The ends of the suture are pulled around the tube and tied together. This will form a seal around the tube. To provide mucosal inversion and a tight seal, it may be necessary to turn the edges in with a tool. The purse-string suture allows the round skin defects to be completely or partially closed after surgery. It may be particularly suitable for elderly patients due to skin laxity. The tension provided by the suture advances the skin uniformly from the entire circumference of the wound, resulting in a significant reduction in defect size and increased hemostasis at the wound edge. When the history of purse-string sutures, changes in technique, advantages and potential complications are reviewed; It appears to be beneficial after removal of non-melanoma skin cancer and also after local melanoma excision. In addition, this technique is particularly suitable for patients who are unable to change their active lifestyle during the week after surgery, simultaneously treated with anticoagulants, antiplatelet agents or both, and patients with extensive post-operative defects. Otherwise it requires skin graft or a large cutaneous flap. Typically, the surgical wound site shows excellent long-term functional results following partial or complete closure with a purse-string stitch. The purse-string suturing was first described in dermatological surgery. It is a simple technique that can be used to reduce the surface area of circular wounds to achieve minimal scarring. To complete the reconstruction and insert a small skin graft, the wound is sutured to reduce both the length and the transverse dimensions of the wound. Beside the bilateral adjacent tissue transfer, a purse-string stitch is used. Using this procedure, large facial imperfections are covered or reduced. It is recommended to use the purse-string sutures as a single procedure that allows the small and medium skin defects to be permanently closed, especially when side-by-side closure is not recommended due to the slackness of the weak tissue. This technique is designed to reduce or eliminate the size of a wound, depending on the degree of tension and the size of the wound. This is a niche technique because the purse-string effect tends to cause a slight shrinkage in the surrounding skin (and will likely be resolved over time), this is an acceptable feature in areas such as the forearm and back, but less desirable in cosmetically sensitive areas such as the face. The nature of the technique indicates that at any point during suture placement, stitch weakening may result in wound dehiscence. However, a larger sized suture material is often used for this reason.
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