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Grundlagen und Techniken der chirurgischen Naht

Bases and methods of suturing

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Zusammenfassung

Obwohl unser Wissen über die Wundheilung durch Grundlagenforschung und klinische Studien stetig wächst und wirksame pharmakologische Methoden zur Modulation der Narbenbildung entwickelt werden, bleiben sorgfältige Gewebehandhabung und akkurate Nahttechnik die wichtigsten Faktoren in der Erzeugung einer ästhetisch günstigen Narbenbildung. Kunstgerechte Inzisionen erfordern grundlegende Kenntnisse über die Hautspannungslinien. Weitere kritische Elemente stellen eine scharfe und saubere Schnittführung, das Vermeiden von Wundhöhlen, ein schichtweiser Wundverschluss sowie eine Eversion der Wundränder dar. Tiefe dermale Nähte richten die Wundränder auf und helfen die Hautspannung beim Wundverschluss zu vermindern. Hautnähte, möglichst intrakutan, werden unter minimaler Spannung eingebracht und greifen vorwiegend tiefe Anteile der Dermis, ohne die Epidermis zu tangieren. Moderne synthetisch hergestellte nichtresorbierbare monofile sowie resorbierbare monofile Fäden erzeugen nur minimale Gewebereaktivität und werden daher für den Hautverschluss bevorzugt, insbesondere wenn kosmetische Aspekte im Vordergrund stehen. Intrakutane fortlaufende Nähte führen in Wunden, die unter geringer Spannung stehen, zu kosmetisch sehr guten Ergebnissen. Im Gegensatz zu Einzelnähten, ermöglichen jedoch fortlaufende Nähte keine differenzierte Anpassung der Nahtspannung, die in einigen komplexen Wunden nötig werden kann. Cyanoacrylat-Klebstoffe stellen lediglich bei oberflächlichen Hautwunden ohne Spannung eine praktikable Methode der Wundrandadaptation dar. Eine kostengünstige Alternative besteht hier in der Anwendung einfacher mikroporöser Tapes über resorbierbaren subdermalen Einzelknopfnähten.

Abstract

If pharmaceutic modulation of scar formation does not improve the quality of the healing process over conventional healing, the surgeon must rely on personal skill and experience. Therefore a profound knowledge of wound healing based on experimental and clinical studies supplemented by postsurgical means of scar management and basic techniques of planning incisions, careful tissue handling, and thorough knowledge of suturing remain the most important ways to avoid abnormal scarring. This review summarizes the current experimental and clinical bases of surgical scar management.

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  1. Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 3, 30625, Hannover, Deutschland

    P.M. Vogt, M.A. Altintas, C. Radtke & M. Meyer-Marcotty

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  1. P.M. Vogt
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  2. M.A. Altintas
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  3. C. Radtke
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  4. M. Meyer-Marcotty
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Vogt, P., Altintas, M., Radtke, C. et al. Grundlagen und Techniken der chirurgischen Naht. Chirurg 80, 437–447 (2009). https://doi.org/10.1007/s00104-009-1670-7

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