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¡¾2556¡¿Pediatric characteristics

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    The most important thing is that its high elasticity makes it excellent in vascular suturing.

    To put it simply, the blood in blood vessels has peaks and valleys that fluctuate with blood pressure.  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 rope without elasticity.  When the amount of fluid in the blood vessels is at a low point, it can shrink back well to promote healing of the wound.

    The unique advantage of polypropylene thread is undoubtedly very suitable for anastomosis of the large blood vessels in and out of the heart, the largest blood pump in the human body.

    In adult heart transplantation, polypropylene sutures are enough.

    When it comes to pediatrics, it¡¯s different.

    In pediatrics, pediatric surgeons need to focus on the characteristics of children¡¯s growth and development. This is the same in pediatric orthopedics as in other pediatric surgeries.  When it comes to anastomosis of large blood vessels for heart transplantation in pediatric cardiac surgery, on the one hand, pediatricians need to be concerned that children's blood vessels will grow longer, and on the other hand, they can focus on the advantages of children's strong metabolism compared to adults.

    Comprehensive consideration, doctors can use absorbable sutures to match non-absorbable sutures at this place, giving the child's own human tissue more room for self-repair at the anastomosis.

    It means that in this operation, when the doctor sews a vascular anastomosis, he can use half of it 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 sutures will disappear before the wound heals, which also means that the suture has failed.

    There are many kinds of absorbable sutures on the market, some degrade quickly and some degrade slowly. This refers to the time it takes for the suture to disappear in the human body.  Is it enough to choose sutures that degrade slowly for slow-healing human tissues?

    No, although some absorbable sutures degrade slowly, they provide a shorter tension support time of 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 sutured needs strong tension support.  Consideration must be given to the time the support is to be placed in tension if required.

    For example, peritoneal suturing, such as current vascular suturing, all have special requirements for tension support, so this needs to be considered.  For this reason, the absorbable suture commonly used clinically in pediatrics is PDS suture.  In this case, is it okay to place this line on the large blood vessels of adults?  no.  Compared with polypropylene thread, it is still inferior.

    The above just shows once again that medicine is an engineering discipline.

    The doctor¡¯s choice of suture material and how to use it well are also technical issues.  Whether it is polypropylene thread or PDS thread, they both have one thing in common: they are too slippery.  If it slips through human tissue, it is convenient and less harmful. On the other hand, the pain point is that it is easy to slip out after tying the knot.  Use these two threads to tie a knot with other materials, and the doctor needs to tie them with several knots.  It¡¯s not good to tie too many knots.  As for the suture method, interrupted suture is not suitable, and continuous suture is used.

    Before suturing, once again determine the next six anastomotic sutures and sequence them first.  The first choice is the left pulmonary vein group, because the location here belongs to the posterior wall of the heart.

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