How do stitches work to close wounds. What are the different types of sutures available. When should you seek medical attention for a cut. How is the stitching procedure performed. What is the proper care for healing stitches. How are stitches removed. What alternative wound closure methods exist.

Understanding the Purpose of Stitches in Wound Healing

Stitches, also known as sutures, play a crucial role in the healing process of wounds and surgical incisions. Their primary purpose is to hold tissue together, allowing the body’s natural healing mechanisms to take effect. By bringing the edges of a wound into close proximity, stitches create an optimal environment for tissue regeneration and minimize the risk of infection.

Why are stitches so important in wound management? They serve several key functions:

• Promote faster healing by keeping wound edges aligned
• Reduce the risk of infection by sealing the wound
• Minimize scarring by ensuring proper tissue alignment
• Control bleeding by closing blood vessels
• Provide support to the wound during the healing process

Understanding when stitches are necessary can help you make informed decisions about seeking medical care for injuries. While minor cuts and scrapes often heal on their own with basic first aid, more severe wounds may require professional intervention.

Recognizing When a Cut Requires Medical Attention

Determining whether a cut needs stitches isn’t always straightforward. However, certain signs indicate that professional medical assessment is necessary. These include:

• Deep or gaping wounds
• Cuts on the face or areas prone to scarring
• Profuse bleeding that doesn’t stop after 20 minutes of direct pressure
• Numbness in the affected area
• Impaired function in a hand or limb after injury
• Jagged or irregular wound edges

Are there instances where stitches might not be advisable? Indeed, certain types of injuries, such as puncture wounds, may not be suitable for stitching. However, these cases still warrant medical evaluation, especially if you haven’t had a tetanus shot in over five years.

Immediate First Aid for Severe Cuts

If you suspect a cut may need stitches, take these steps while seeking medical care:

1. Apply direct pressure to control bleeding
2. Elevate the injured area above heart level, if possible
3. Clean the wound gently with mild soap and water
4. Cover the injury with a clean, sterile dressing

The Stitching Procedure: What to Expect

Understanding the stitching process can help alleviate anxiety if you find yourself needing sutures. The procedure typically involves several steps, each designed to ensure optimal healing and minimize discomfort.

Preparation and Anesthesia

How does a healthcare provider prepare a wound for stitching? The process usually begins with a thorough assessment of the injury. The area around the wound is cleaned, and a local anesthetic is often administered to ensure your comfort during the procedure. In some cases, particularly with contaminated wounds, cleaning may take priority over numbing to prevent infection.

Wound Examination and Debris Removal

Once the area is numb, the healthcare provider will carefully examine the wound. They’ll look for any foreign objects, dirt, or debris that could impede healing or cause infection. In some cases, an X-ray might be ordered to detect deeply embedded materials, especially if the injury was caused by glass or metal.

Is removal of dead tissue necessary? Sometimes, the doctor may need to debride the wound, removing any dead or severely damaged tissue to promote better healing.

The Suturing Process

How are stitches actually placed? The doctor will carefully align the edges of the wound and use a needle to pass surgical thread through both sides of the cut. Each stitch is tied off to hold the wound closed. The type of thread used can vary based on the wound’s location and severity.

Types of Sutures and Their Applications

Not all sutures are created equal. Different types of surgical thread are used depending on the specific needs of the wound and the patient. Understanding these variations can provide insight into the healing process.

Non-absorbable Sutures

What are non-absorbable sutures? These are stitches made from materials like silk or nylon that do not break down in the body. They’re typically used for external wounds and need to be removed once healing is complete.

Absorbable Sutures

How do absorbable sutures work? These stitches are designed to dissolve over time as the wound heals. They’re often used for deep cuts or internal wounds, eliminating the need for removal.

Monofilament vs. Braided Sutures

What’s the difference between monofilament and braided sutures? Monofilament sutures consist of a single thread, while braided sutures are made of multiple fibers twisted together. Each type has its advantages, with monofilament sutures being less likely to harbor bacteria, while braided sutures often provide greater strength and flexibility.

Post-Procedure Care: Nurturing the Healing Process

Proper care of your stitches is crucial for optimal healing and minimizing the risk of complications. Following your healthcare provider’s instructions diligently can make a significant difference in your recovery.

Cleaning and Dressing the Wound

How should you clean a wound with stitches? Your doctor will provide specific instructions, but generally, you’ll need to keep the area clean and dry. This may involve gently washing with mild soap and water, followed by careful patting dry. In some cases, you might be advised to apply an antibiotic ointment to prevent infection.

Monitoring for Signs of Infection

What are the warning signs of infection in a sutured wound? Be vigilant for symptoms such as:

• Increased redness or swelling around the wound
• Warmth or tenderness in the affected area
• Pus or unusual drainage from the wound
• Fever above 100°F (37.8°C)
• Red streaks extending from the wound

If you notice any of these signs, contact your healthcare provider promptly.

Activity Restrictions and Wound Protection

How can you protect your healing wound? Depending on the location and severity of your injury, your doctor may recommend limiting certain activities. This could include avoiding swimming, strenuous exercise, or activities that might put stress on the stitches. You may also be advised to keep the wound covered or elevated in certain situations.

The Stitch Removal Process: Completing the Healing Journey

The removal of stitches marks a significant milestone in the healing process. Understanding what to expect can help alleviate any anxiety about this final step.

Timing of Stitch Removal

How long do stitches typically stay in place? The duration varies depending on the location and severity of the wound. Generally, stitches remain in place for:

• Face: 3-5 days
• Scalp: 7-10 days
• Arms and legs: 10-14 days
• Chest or back: 10-14 days
• Hands or feet: 10-14 days

Your healthcare provider will determine the appropriate time for removal based on your specific case.

The Removal Procedure

What does the stitch removal process entail? It’s a relatively quick and painless procedure. Your doctor will use sterile scissors to cut each stitch near the knot and then gently pull it out. You might feel a slight tugging sensation, but it shouldn’t be painful.

Is anesthesia needed for stitch removal? Unlike the initial stitching process, removing sutures typically doesn’t require anesthesia.

Post-Removal Care

How should you care for your wound after stitch removal? Your doctor may provide specific instructions, which might include:

• Keeping the area clean and dry
• Applying sunscreen to minimize scarring if the wound is exposed to sunlight
• Using silicone-based scar treatments to improve the appearance of the healed wound
• Massaging the scar tissue to promote flexibility and reduce tightness

Alternative Wound Closure Methods: Beyond Traditional Stitches

While stitches are a common and effective method for wound closure, they’re not the only option available. Advancements in medical technology have introduced several alternatives, each with its own advantages in certain situations.

Adhesive Strips and Butterfly Closures

How do adhesive strips work for wound closure? These thin, sticky strips can be used to hold the edges of small, shallow cuts together. They’re often used for minor wounds that don’t require full stitches or in conjunction with other closure methods.

When are butterfly closures appropriate? These adhesive strips are particularly useful for:

• Closing small cuts on areas with minimal skin tension
• Reinforcing healing wounds after stitch removal
• Providing additional support to wounds closed with other methods

Surgical Staples

What are the benefits of surgical staples? Staples can be quickly applied, making them ideal for closing long incisions or wounds in areas of high tension. They’re commonly used in emergency situations or during surgeries where speed is crucial.

How are surgical staples removed? Like stitches, staples are typically removed once the wound has healed sufficiently. A special staple remover is used to quickly and easily remove them.

Tissue Adhesives (Surgical Glue)

How does surgical glue work to close wounds? Tissue adhesives are liquid substances that bond the edges of a wound together as they dry. They’re particularly useful for:

• Closing straight, clean cuts
• Sealing surgical incisions
• Providing a waterproof barrier over the wound

What are the advantages of using tissue adhesives? They offer several benefits, including:

• No need for removal (they naturally slough off as the wound heals)
• Reduced risk of infection compared to traditional sutures
• Faster application time
• Less pain during application

Combination Approaches

Can different wound closure methods be used together? Yes, in some cases, a combination of techniques might be employed. For example, deep layers of a wound might be closed with absorbable sutures, while the surface is sealed with tissue adhesive or adhesive strips.

The choice of wound closure method depends on various factors, including the type and location of the wound, the patient’s overall health, and the healthcare provider’s expertise. Each method has its place in modern wound care, allowing for personalized treatment approaches that optimize healing and minimize scarring.

Innovations in Suture Technology: The Future of Wound Closure

As medical science advances, so too does the technology behind wound closure. Researchers and medical device companies are continually developing new and improved suture materials and techniques to enhance healing outcomes and patient comfort.

Smart Sutures

What are smart sutures? These innovative stitches incorporate sensors that can monitor various aspects of the healing process, such as:

• Wound temperature (to detect infection)
• Strain on the wound (to prevent dehiscence)
• pH levels (to assess healing progress)

How do smart sutures benefit patients? By providing real-time data on wound healing, these sutures allow for early detection of complications and personalized treatment adjustments.

Antimicrobial Sutures

How do antimicrobial sutures work? These sutures are coated with or incorporate antimicrobial agents that help prevent infection at the wound site. They’re particularly useful in surgeries with a high risk of post-operative infection.

Barbed Sutures

What are the advantages of barbed sutures? These sutures feature tiny barbs along their length that anchor into the surrounding tissue, eliminating the need for knots. Benefits include:

• Faster closure times
• More even distribution of tension along the wound
• Reduced risk of wound separation

Bioabsorbable Sutures with Controlled Degradation

How are new bioabsorbable sutures improving wound care? Advanced materials science is producing sutures that can be programmed to degrade at specific rates, matching the healing timeline of different types of tissues and wounds.

As these and other innovations continue to develop, the future of wound closure looks promising, with potential improvements in healing times, reduced complications, and enhanced patient outcomes. The field of suture technology remains an exciting area of medical research, promising to revolutionize wound care in the coming years.

Stitches (Sutures): Purpose, Procedure, Recovery

Written by Anne Brinser Shelton

• Signs a Cut May Need Stitches
• The Procedure
• Caring for Stitches
• Removal of Stitches
• Other Options

Most minor cuts and scrapes heal on their own, with little more intervention needed than mild soap and water to keep them clean. But more serious cuts or incisions from surgical procedures may require stitches, or sutures, to hold tissues together while they heal. The goal is to piece together the edges so that skin and other tissues can fuse back together. Then the stitches are removed.

Although it’s natural to feel a little anxious if you’re getting stitches, especially if you’ve just experienced trauma, the procedure is generally painless. And stitches will help cuts heal with minimal scarring or risk for infection.

It’s not always easy to tell if a cut requires stitches. Ultimately, it’s up to your health care provider to determine if stitches are needed. You should seek medical care for any cut that:

• Is deep, jagged, or gaping
• Is on the face or another part of the body where scarring may be an issue
• Bleeds profusely without stopping after 20 minutes of direct pressure
• Feels numb
• Is in a hand or limb that doesn’t function properly after being cut

If any of these criteria apply to your injury, see a doctor as soon as you can. In the meantime, apply direct pressure to help control bleeding. It might also help to raise the injured area above the level of your heart, if possible.

There are certain instances in which stitches may not be advised, such as puncture wounds, though you may still need to see a doctor, especially if you have not had a tetanus shot in more than five years.

Once a health care provider has assessed your injury and determined that you need stitches, the first steps they will take in treating the wound are to clean and numb the area, though not necessarily in that order. Although cleaning a wound is not very painful in most cases, the doctor may first administer a local anesthetic, similar to what your dentist might use, to maximize your comfort. If your injury seems particularly contaminated, however, cleansing it — usually with running tap water and a mild soap — may be a higher priority.

Once the area is numb, the doctor will take a closer look to make sure there’s no dirt, debris, or other foreign objects inside the cut before sewing it together. An X-ray may also be ordered to help look for remaining debris. If you cut yourself on a piece of glass or sharp metal, for instance, it’s crucial to ensure that there are no remaining shards inside the cut.

The doctor may remove any dead tissues to help the healing process. They will then pull the edges of the cut together and, for each stitch, loop thread through either side of the cut and tie a knot to hold the wound closed.

Doctors can use different types of surgical thread made from materials such as silk or nylon, which may be in single filaments or braided. There’s even surgical thread that is designed to dissolve over time so that the stitches don’t need to be removed. These are used most frequently in deep cuts.

The doctor or nurse will give you instructions for caring for your stitches as your cut heals. These may include specific steps for cleaning and dressing the wound. You may be advised to keep the wound and bandages dry.

Your doctor may also recommend an antibiotic ointment to help prevent infection and make you aware of signs that may indicate infection. Keep an eye out for such signs, including a fever higher than 100 degrees or red streaks on the skin near the wound. And if any of your stitches pop or break, or you have any other concerns, be sure to contact your doctor.

Stitches typically need to remain in place for several days to a couple of weeks, depending on the severity of the cut and location. Your doctor will tell you when to come back to have them taken out. Removing stitches is a much faster process than putting them in. The doctor simply clips each thread near the knot and pulls them out. You may feel a slight tugging sensation, but the removal of stitches shouldn’t hurt at all. You won’t even need an anesthetic.

Although removing stitches is not a difficult process, you shouldn’t try to remove them yourself. It’s important for your doctor to check to see that the wound is healing properly and to make sure that it’s OK for the stitches to come out. The doctor may also have special instructions for you after the stitches are removed, which may help minimize scarring.

Stitches aren’t the only option doctors have to close cuts and incisions. Cuts sometimes can be held together with butterfly tape or adhesive strips, which you may be able to do yourself at home for more minor cuts. There are even special staples or tissue glue, but those tend to work best with clean, straight incisions, such as in surgical procedures.

There are different criteria and care instructions for each type of closure. Your health care provider can help decide which is best for you and tell you how to care for your injury as it heals.

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Stitches (Sutures): Purpose, Procedure, Recovery

Written by Anne Brinser Shelton

• Signs a Cut May Need Stitches
• The Procedure
• Caring for Stitches
• Removal of Stitches
• Other Options

Most minor cuts and scrapes heal on their own, with little more intervention needed than mild soap and water to keep them clean. But more serious cuts or incisions from surgical procedures may require stitches, or sutures, to hold tissues together while they heal. The goal is to piece together the edges so that skin and other tissues can fuse back together. Then the stitches are removed.

Although it’s natural to feel a little anxious if you’re getting stitches, especially if you’ve just experienced trauma, the procedure is generally painless. And stitches will help cuts heal with minimal scarring or risk for infection.

It’s not always easy to tell if a cut requires stitches. Ultimately, it’s up to your health care provider to determine if stitches are needed. You should seek medical care for any cut that:

• Is deep, jagged, or gaping
• Is on the face or another part of the body where scarring may be an issue
• Bleeds profusely without stopping after 20 minutes of direct pressure
• Feels numb
• Is in a hand or limb that doesn’t function properly after being cut

If any of these criteria apply to your injury, see a doctor as soon as you can. In the meantime, apply direct pressure to help control bleeding. It might also help to raise the injured area above the level of your heart, if possible.

There are certain instances in which stitches may not be advised, such as puncture wounds, though you may still need to see a doctor, especially if you have not had a tetanus shot in more than five years.

Once a health care provider has assessed your injury and determined that you need stitches, the first steps they will take in treating the wound are to clean and numb the area, though not necessarily in that order. Although cleaning a wound is not very painful in most cases, the doctor may first administer a local anesthetic, similar to what your dentist might use, to maximize your comfort. If your injury seems particularly contaminated, however, cleansing it — usually with running tap water and a mild soap — may be a higher priority.

Once the area is numb, the doctor will take a closer look to make sure there’s no dirt, debris, or other foreign objects inside the cut before sewing it together. An X-ray may also be ordered to help look for remaining debris. If you cut yourself on a piece of glass or sharp metal, for instance, it’s crucial to ensure that there are no remaining shards inside the cut.

The doctor may remove any dead tissues to help the healing process. They will then pull the edges of the cut together and, for each stitch, loop thread through either side of the cut and tie a knot to hold the wound closed.

Doctors can use different types of surgical thread made from materials such as silk or nylon, which may be in single filaments or braided. There’s even surgical thread that is designed to dissolve over time so that the stitches don’t need to be removed. These are used most frequently in deep cuts.

The doctor or nurse will give you instructions for caring for your stitches as your cut heals. These may include specific steps for cleaning and dressing the wound. You may be advised to keep the wound and bandages dry.

Your doctor may also recommend an antibiotic ointment to help prevent infection and make you aware of signs that may indicate infection. Keep an eye out for such signs, including a fever higher than 100 degrees or red streaks on the skin near the wound. And if any of your stitches pop or break, or you have any other concerns, be sure to contact your doctor.

Stitches typically need to remain in place for several days to a couple of weeks, depending on the severity of the cut and location. Your doctor will tell you when to come back to have them taken out. Removing stitches is a much faster process than putting them in. The doctor simply clips each thread near the knot and pulls them out. You may feel a slight tugging sensation, but the removal of stitches shouldn’t hurt at all. You won’t even need an anesthetic.

Although removing stitches is not a difficult process, you shouldn’t try to remove them yourself. It’s important for your doctor to check to see that the wound is healing properly and to make sure that it’s OK for the stitches to come out. The doctor may also have special instructions for you after the stitches are removed, which may help minimize scarring.

Stitches aren’t the only option doctors have to close cuts and incisions. Cuts sometimes can be held together with butterfly tape or adhesive strips, which you may be able to do yourself at home for more minor cuts. There are even special staples or tissue glue, but those tend to work best with clean, straight incisions, such as in surgical procedures.

There are different criteria and care instructions for each type of closure. Your health care provider can help decide which is best for you and tell you how to care for your injury as it heals.

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Device of working seams when laying concrete mix.

Details

Parent category: Articles

Posted on 08 October 2014

Created on 08 October 2014

To ensure solidity, it is desirable to concrete the structure continuously . But this is possible only with small amounts of work and in relatively simple designs. In all other cases, breaks in concreting are inevitable. If it is necessary to arrange breaks in the concreting of structures, the so-called working joints are used.

Working joint is the joint plane between hardened and new (freshly placed) concrete, formed due to a break in pouring. A working joint is formed when subsequent layers of the concrete mixture are laid on top of the fully cured previous ones. This usually happens during breaks in concreting from 7 hours.

Service joints are a weak point, so they must be located in sections where the joints of old and new concrete cannot adversely affect the strength of the structure. In columns, working joints are allowed at the level of the top of the foundation, at the bottom of purlins, beams or crane consoles, at the bottom of the capitals of columns of beamless ceilings; in frame structures – at the top of the haunch between the uprights and crossbars of the frames. In beams, working seams are allowed within the middle part of the span. When concreting ribbed slabs, one should be guided by the following: if concreting proceeds in a direction parallel to the secondary beams, the working seam is allowed within the middle third of the span of the beams; when concreting in a direction parallel to the main beams (girders) – within two middle quarters of the span of beams and slabs. In beamless ceilings, working seams are made in the middle of the span of the slab. Working seams in beams and slabs are formed in the form of a vertical cut.

Interrupted concreting can be resumed after the setting process is completed in the previously laid concrete mixture and the concrete acquires a strength of at least 1.5 MPa (capable of absorbing a slight dynamic impact without destruction).

The surface of the working joint must be perpendicular to the axis of the element, and in walls and slabs – to their surfaces. To do this, install shields – limiters with slots for reinforcing bars, attaching them to the formwork panels.

For reliable adhesion of concrete in the working joint, the surface of the previously laid concrete is carefully treated: the edge of the set concrete is cleaned of the cement film and the coarse aggregate is exposed, wiping with wire brushes; blow out with compressed air and rinse with a stream of water. Particularly carefully treat the surface of the concrete around the outlets of the reinforcement; reinforcing bars are cleaned of the solution. Before concreting, the cleaned joint surface is covered with a cement mortar having the same composition as the concrete mixture being laid.

Construction of construction joints during concreting

Moscow

During the creation of a concrete structure, it is most optimal to pour the full volume of the concrete mixture, forming a homogeneous layer. However, sometimes it is necessary to carry out concreting work intermittently, in several stages. Such a scheme is mainly used when working with objects of a large area or complex geometric shapes, where continuous concreting in one layer is technically difficult or completely impossible.

In such cases, the concrete mixture is poured into several adjacent layers, while the formwork is filled with the next layer of concrete after the previous one has gained the necessary strength. During the connection of adjacent layers of the concrete mix, the so-called cold or working seam is formed, the strength and reliability of the structure does not decrease if the work is performed in accordance with the technology.

Concreting joints

The developer always tries to perform concreting in one step, taking measures to eliminate the causes of downtime, for example, by increasing the number of equipment and workers, increasing the load capacity of scaffolding, but it is still very difficult to completely eliminate the formation of working joints, especially when working with the most complex structures that are being created. by technology involving multi-layer concreting.

In addition to the targeted use of this technology, there are various prerequisites for the formation of working seams:

• Equipment failure;

• The need to install a reinforcing cage;

• Limiting the peak load on a specific structural element;

• Lack of materials.

Regardless of the reasons for the occurrence of seams, the next layer of concrete is poured with the previous layer already partially solidified, so it is necessary to arrange the seam in such a way as to exclude the possibility of any mobility of the joints of the layers relative to each other and maintain the integrity and reliability of the structure.

Construction of working joints during concreting according to SNiP

The joints of the layers of the concrete mix are a weakened structural element, so their installation must be carried out in strict accordance with the standards. It is not recommended to place seams in load-bearing structural elements, where the strongest mechanical impact is expected, which can adversely affect the strength and durability of the entire future structure.

SNiP 3.03.01-87 “Bearing and enclosing structures” – a regulatory document that regulates the process of creating monolithic concrete and reinforced concrete structures. Clause 2.13 of the current document contains a list of requirements for the construction of working seams.

According to the provisions specified in the standard, the surface of the working joints that are formed during the multi-stage laying of the concrete mixture must be perpendicular to the axis of the concreted objects. The resumption of the concreting process is possible upon reaching the already laid layer of the concrete mixture with a strength of at least 1.5 MPa. It is allowed to place working seams when working with the following objects:

• Columns with the formation of a cold joint at the level of the bottom of the girders, capitals, the top of the foundation or crane beams;

• Separate beams with a seam device within the middle third of the span;

• Beams monolithically connected to the slabs – the seam is located 2 – 3 cm below the mark of the lower surface of the slab, in case of having haunches – at the mark of the bottom of the haunch of the slab;

• Flat slabs – anywhere parallel to the smallest side of the slab;

• Ribbed floors – parallel to secondary beams;

• Arches, vaults, bunkers, tanks, hydraulic structures and other most complex engineering structures.

All seam locations must be agreed with the design organization and must be indicated in the design documentation for the construction site. In the event that a seam may affect strength, stiffness or waterproofing, this should also be indicated on the relevant shop drawings.

Waterproofing joints during concreting

It should be borne in mind that in the area where the joints are placed, the insulating function of the concrete structure is significantly reduced. The location of the working seam can become a zone of moisture accumulation, which creates a serious threat of chemical decomposition of concrete and corrosion of reinforcement. Under the operating conditions of the object at low temperatures, the moisture that has entered the cavity of the concrete structure freezes, and when thawed, it causes internal stresses, and, as a result, mechanical destruction of concrete.

In order to avoid wear of the building material, high-quality waterproofing is provided in the area where the working seam is located. Several basic waterproofing methods are widely used:

High quality waterproofing work will ensure the elasticity of cold joints, resistance to moisture, mold and significant temperature fluctuations. In addition, waterproofing avoids clogging of the joints, which positively affects their service life, as well as the structure as a whole. It must be remembered that a cold joint is a critical element of a concrete or reinforced concrete structure, and the reliability and durability of the future building depend on the correct device and further care.

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Table of characteristics of concrete mixtures

Grade	Brand	Euro class	Mobility	Strength	Waterproof impermeable	Frost resistance	Hardness
B10	М150	c8/10	P2 – P4	163 kg/cm2	W2 – W4	F 50	W1 – W4
B15	M200	s12/15	P2 – P4	196 kg/cm2	W2 – W4	F 100	W1 – W4
B20	M250	s16/20	P2 – P4	275 kg/cm2	W4 – W6	F 150	W1 – W4
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