2556 Pediatric Features
Most importantly, its high elasticity makes it excellent for suturing blood vessels.
To put it simply, the blood in the blood vessels will fluctuate with the fluctuation of blood pressure, with peaks and valleys. When the fluid in the blood vessel is full, it pulls the anastomosis, which can be stretched like a rubber band and not easily broken like a non-elastic rope. When the amount of fluid in the blood vessel is at a low point, it can shrink back very well to allow the opening to heal.
The unique advantages of polypropylene thread are undoubtedly very suitable for the anastomosis of the heart, the largest blood pump in the human body, into and out of the large blood vessels.
In adult heart transplants, indeed, only polypropylene sutures are sufficient.
In pediatrics, it's different.
In pediatrics, pediatric surgeons need to focus on the characteristics of children's growth and development. In pediatric orthopedics, it is the same as in other pediatric surgeries. In the anastomosis of large blood vessels for heart transplantation in pediatric cardiology surgery, pediatricians need to be concerned that children’s blood vessels will grow longer, and on the other hand, they can focus on considering that children’s vigorous metabolism is an advantage compared to adults.
On a comprehensive basis, doctors can use absorbable sutures to match non-absorbable sutures in this place, giving the child's own human tissue more room for self-healing and fault tolerance at the anastomosis.
It is equivalent to saying that in this operation, the doctor can sew a vascular anastomosis, half of which can be used with non-absorbable sutures and half with absorbable sutures.
How to choose absorbable sutures. Remember, absorbable sutures are absorbed by the body. Therefore, what the doctor has to do is to ensure that the absorbable sutures are not absorbed by the body before the wound heals. Otherwise, the lines will disappear before the wound heals, which also means that the sutures have failed.
There are many kinds of absorbable sutures on the market, and some degrade quickly while others degrade slowly. This refers to the disappearance time of the sutures in the human body. Is it enough to choose sutures that degrade slowly on slow-healing human tissues?
No, although some absorbable sutures degrade slowly, they provide a shorter tension support time, only a few days, which is not as good as sutures that degrade quickly and have a long tension support time. Therefore, when choosing this kind of suture, you should pay special attention to whether the human tissue you are suturing needs strong tension support. Must consider is the time to place tension braces if required.
Such as peritoneal suture, such as the current suture of blood vessels, all have special requirements for tension support, so this point needs to be considered. For this reason, the commonly used absorbable suture in pediatrics here is PDS thread. That being the case, is it okay to put this line in the adult blood vessel? no. Compared with polypropylene thread, it is still worse.
The above just shows once again that medicine is properly an engineering discipline.
It is also a technical issue for doctors to choose a good suture material and how to use it well. Be it polypropylene thread or PDS thread, both have one thing in common, which is too slippery. If it is slippery, it is convenient to pass through the human tissue and less damage. On the other hand, the pain point is that it is easy to slip out after the end. Use these two kinds of thread to tie the knot, other materials tie a knot, and the doctor needs to tie several knots for them. Too much knotting is not good either. In terms of the suture method, intermittent sutures are not suitable, and continuous sutures are used.
Before suturing, determine the next six anastomotic sutures again, and make a sequence. The left pulmonary vein group was selected first, because the position here belongs to the posterior wall of the heart.