2008年7月25日 星期五

手術縫線的選擇III







這次要討論的是非吸收線.

(一)多股非吸收線
1. Sofsilk (Syneture)及Silk (Ethicon) - 就是絲線.事實上這種線材十四天後也會失去30%的線材韌性,而且組織反應也較大,傷口也容易受感染.唯一好處就是很容易使用,可說是學習外科醫生結(Surgeons' Knot)的標準線材.如果連silk都用得不好,你以後也別再做手術了!
2. Supramid - 為polymerised caprolactum.如果外層破裂的話,和silk一樣傷口會容易受感染.一般而言只會用在非感染性的皮膚縫合,比silk略勝一籌.如果用cassette包裝的話,因為只有泡消毒水的關係,感染率高,而且要自己接針,比較不方便.

(二)單股非吸收線 - 在"東方之珠"這裡也是比較不太受歡迎.其實已有很多外科專科獸醫建議用nylon來縫合皮膚,因為不用管到底傷口是否感染性的.很多醫生選擇用Supramid代替,可能是因為手術結相對多股線來得好打結,其實是不行的!
1.Ethilon - Ethicon公司出品的Nylon,約兩年才會失去30%的韌性.價錢不貴,而且組織反應極低.

2. Monosof / Dermalon - Syneture公司出產的Nylon.兩者的材料是一樣的,不過前者是黑色或透明的,後者是藍色而已.
3. Prolene - Ethicon公司的另一旗艦級的線材(polypropylene).用來縫合高度感染的傷口,心肌,疝氣或高危的腸道手術.組織反應極低,但非常昂貴!
4. Surgipro - Syneture公司的polypropylene,個人認為和Prolene幾乎一樣但價錢比較便宜!

個人選擇:Sofsilk 0, 2-0, 3-0, 5-0; Monosof 0, 2-0, 3-0, 4-0; Ethilon 2-0, 3-0, Surgipro 0, 2-0, 3-0, 4-0;

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