Chapter 2556: Pediatric Characteristics

Most importantly, its high elasticity makes it perform exceptionally well in vascular suturing.

Simply put, blood inside the vessel will fluctuate with blood pressure in peaks and troughs. When the vessel is filled with fluid, it stretches the anastomosis like a rubber band, avoiding a rigid break like a non-elastic rope. When fluid levels are low, it can contract back effectively to promote healing.

This unique advantage of polypropylene sutures is undoubtedly very suitable when used in the anastomosis of large blood vessels entering and exiting the heart, the body’s largest blood pump.

In adult heart transplants, indeed, using only polypropylene sutures is sufficient.

However, it’s different in pediatrics.

In pediatrics, pediatric surgeons need to focus on the characteristic of children’s growth and development, which applies in pediatric orthopedics and in other pediatric surgeries alike. In pediatric cardiac surgery for large vessel anastomosis in heart transplants, pediatricians need to consider the lengthening of children’s blood vessels on one hand and the advantage of their vigorous metabolism compared to adults on the other.

Considering these factors, doctors can use absorbable sutures alongside non-absorbable ones, providing more room for self-repair at the anastomosis site in the pediatric patient’s tissues.

This means that in this surgery, a doctor can suture a vascular anastomosis using half non-absorbable and half absorbable sutures.

How to select absorbable sutures. Remember, absorbable sutures will be absorbed by the body. Therefore, doctors must ensure the suture is not absorbed before the wound heals; otherwise, if the wound isn’t healed well before the suture disappears, it also means suture failure.

There are many kinds of absorbable sutures on the market; some degrade quickly while others degrade slowly, referring to the disappearance time of the sutures inside the body. Should you just choose slow-degrading sutures for slow-healing body tissues?

No, some absorbable sutures degrade slowly but provide tension support for a shorter time, only a few days, which isn’t as good as quickly degrading that provide longer tension support. So, when choosing such sutures, pay attention to whether your sutured tissue needs strong tension support. If needed, focus on the tension support duration.

For peritoneal sutures or current vascular sutures, both have special requirements for tension support, so this must be a key consideration. Thus, clinically in pediatrics, PDS sutures are commonly used. Given this, can these be used on adult large vessels? No, they are still inferior compared to polypropylene sutures.

The above ultimately reiterates that medicine is truly an engineering discipline.

Selecting the right suture material is essential, and using it properly is also a technical issue. Both polypropylene and PDS sutures share a common trait – very slippery. Being slippery means they pass through human tissue causing minimal harm; on the other hand, the challenge is that they can easily slip out after being tied. When using these two types of sutures, when tying knots, more knots are needed than other materials. Too many knots aren’t good either. Regarding suturing technique, interrupted sutures aren’t very suitable; continuous suturing is used.

Before suturing, reconfirm that there are six anastomosis sites to suture, and prioritize them. The first choice is the left pulmonary vein group because its location is on the back wall of the heart.