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SURJET INTRA-DERMIQUE

 

SURJET INTRA-DERMIQUE

 

Il est la meilleure technique de suture de la peau, ne serait-ce qu'à cause de l'absence de trajet cutanéo-dermique du fil et donc par l'absence de marque laissée par l'aiguille le long de la cicatrice.  

Les conditions optimales requises pour un surjet intra-dermique et le meilleur résultat possible sont:

 

- une plaie régulière

 

 

- des lèvres éversées

 

 

- l'absence de perte de substance

 

 

- une tension minimale sur les berges

 

 

- l'absence de risque important de suppuration collectée

 

 

- l'absence de risque important d'hématome

 

 

Technique de réalisation:

Le fil pénètre à une extrémité de la plaie par un passage cutanéo-dermique et il ressort à la pointe par le derme. Ensuite tous les points sont intra-dermiques.

Le passage dermique doit être au même niveau sur les deux berges pour éviter tout chevauchement. La répartition des prises doit être symétrique pour réaliser un bon affrontement sur toute la longueur de la suture.

Ces surjets sont réalisés à l'aide de fils monofilaments d'assez gros calibre (0 ou 2/0) pour pouvoir les retirer sans les casser. Parfois les fils d'acier peuvent être utilisés. Certains surjets sont dits "enfouis" car faits avec du fil résorbable que l'on pourra laisser en place.

Si le surjet est fait avec du fil non-résorbable, on s'assurera régulièrement en cours de réalisation que le fil coulisse bien pour que son ablation puisse se faire sans le casser. Sur de longues plaies, pour les mêmes raisons, on réalisera des boucles superficielles tous les 5 à 7 cm.

En cas d'inégalité des deux berges à suturer, on "trichera"progressivement en prenant des boucles plus larges du côté le plus long, de façon à éviter la formation d'une "oreille" qui aura peu tendance à se résorber spontanément.

A la fin du surjet, l'aiguille pique le derme à la pointe de la plaie et ressort dans son axe par un trajet cutanéo-dermique à 1 cm environ. Le fil est alors arrêté à chaque extrémité par un noeud simple ou des bandelettes auto-adhésives. Il est également possible de nouer les deux extrémités ensemble de façon lâche. Si, à la fin du surjet, certaines petites zones restent désunies, l'affrontement correct peut être amélioré par des Steri-Strips®, par des points séparés simples très superficiels (épidermiques) à l'aide d'un fil très fin (PROLENE® 4/0 ou 5/0 par exemple) ou même parfois par la réalisation d'un surjet intradermique plus superficiel.

Certains surjets peuvent être enlevés très précocemment (dès le 3ème jour pour les paupières, dès le 5ème jour pour les cicatrices péri-aréolaires). Il est possible ailleurs de laisser les fils en place longtemps (15 jours voire 3 semaines), du fait de l'absence de marque de fils sur la peau, lorsqu'il existe une certaine tension, pour que la cicatrice soit déjà solide à l'ablation du fil.

Notons pour information qu'il existe un appareil à surjet intradermique automatique appelé SQS 20. Celui-ci dispose de deux mors qui affronte les berges et un mécanisme entre ces mors enfile automatiquement le derme avec une fléchette résorbable en Lactomer® de 15 mm de long. L'opération est renouvelée sur toute la longueur de la plaie.

 

 

 

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