in this video we'll go over how to place a corner suture in an x-shaped stellate
在本视频中，我们将介绍如何在 X 形星状伤口中进行角缝合
wound your first step will be to start at the
您的第一步是从
farthest edge or the farthest flap and you're going to suture
最远的边缘或最远的皮瓣开始，然后您将
perpendicular to the wound towards another flap edge suturing towards
垂直于伤口向另一个皮瓣缝合 对着自己进行边缘缝合
yourself you're going to enter epidermal but
你将进入表皮，但
you'll be exiting subcuticular within the wound itself
你将在伤口本身内离开表皮
next you'll rearm the needle to suture parallel to the wounds you're going to
下 接下来你将重新装好针以平行于伤口缝合 你
basically be changing 90 degrees in the plane in which you are suturing
基本上将在平面上改变 90 度你正在缝合，
you'll take that adjacent flap edge and you'll retract it with forceps
你将取下相邻的皮瓣边缘，然后用镊子将其缩回
and now you're going to proceed to suture in a subcuticular fashion
，现在你将继续以皮下方式缝合，
so basically parallel with the skin as pictured here
因此基本上与皮肤平行，如图所示
and you want to be really mindful to stay in the same
，你要非常注意在整个缝合过程中保持在同一个
subdermal plane throughout the stitch
皮下平面，
for the next step you're going to rearm the needle and
下一步你要重新装好针，
you're going to again suture parallel to the wound so in the same plane that you
你将再次平行于伤口缝合，所以在你刚刚所在的同一个平面上，
just were this one will likely be the most awkward
这可能是最重要的 st
you're going to need to kind of backhand it ，so make sure you have your needlearmed correctly and ergonomically again. i'd recommend using your forceps and retracting that next adjacent flap edge,and you'll once again suture in a sub particular fashion
你需要反手，所以确保你的持针是正确的，能发挥最大效率。我建议你用镊子把相邻的皮瓣边缘提起来，然后再一次以一种特殊的方式缝合
parallel with the skin as you did in the previous step again be mindful to make
像你在上一步中所做的那样与皮肤平行，再次注意
sure you are in the same subdermal plane throughout that's how this is going to
确保你在整个皮下平面上，这就是如何将它们
come together without accidentally unintentionally inverting any of the
组合在一起，而不会意外地无意地反转任何
wound edges
伤口边缘，
your final throw is going to be much like your first throw but in reverse
你的最后一次投掷将是很像你的第一次扔，但在反向
rearm the suture needle so that it's now perpendicular as in the first step
重新武装缝合针，这样它现在是垂直的，因为在第一步
you're going to enter subcuticular through that far edge and you're going
你要通过那个远的边缘进入皮下，你
to exit epidermally you're going to want to make sure that
要从表皮退出你要确保
you enter in the same subdermal plane that you've been suturing in all along
你进入你一直缝合的同一个皮下平面
and you want to exit epidermal such that you're right across from where you first
，你想离开表皮，这样你就在你第一次
entered the tissue and now you're ready to tie it off
进入组织的地方对面， 现在你已经准备好在这个演示中把它系起来
in this demonstration we're using a 4-0 nylon suture so that will require four
了，我们使用的是 4-0尼龙缝合线，所以这将需要四个
instrument ties to bring it together and as you see it brings the four flaps
仪器系带将它连接在一起，正如你所看到的那样，它将伤口的四个
of this wound together quite nicely you can apply this same technique to an
皮瓣很好地连接在一起，你可以 将同样的技术应用于
infinite number of flap edges so you just have to continue that
无限数量的皮瓣边缘，这样你就必须继续这种
subcuticular pattern until you get to the final flap so you can bring the last
皮下模式，直到你到达最后一个皮瓣，这样你就可以把最后
two together
两个皮瓣放在一起
this is a useful technique for some of the
这对于
odd looking wounds we get in the emergency department