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A seton or seton stitch is a procedure used to aid the healing of fistulae (abnormal connections between two epithelium-lined organs or vessels).
The procedure involves running a surgical-grade cord through the fistula tract so that the cord creates a loop that joins up outside the fistula. The cord provides a path that allows the fistula to drain continuously while it is healing, rather than allowing the exterior of the wound to close over. Keeping the fistula tract open can help prevent the trapping of pus or other infectious material in the wound. The procedure was mentioned by Hippocrates. [1]
Setons can be tied tightly or loosely and with different materials, depending on the anatomical location of the fistulae and what may be medically required. A seton might be tied loosely as a palliative measure to avoid septic and painful exacerbations, or as temporary measure before surgical excision as in fistulotomy or fistulectomy. In some types of fistulae, a seton may be tied with more tension and tightened periodically. In this case, the seton loop will slowly cut through tissue inside the loop while scarring behind the loop, essentially "pulling out" the fistula without surgery. This is the Kshar-Sutra method mentioned by Sushruta in ancient Indian surgical practice.
The seton used to be tied with a knot. The knot is known for causing complaints. Recently knotless setons have been developed and a study in 2020 shows that such a super seton leads to a decrease in discharge and pain. [2]
A fistula in anatomy is an abnormal connection between two hollow spaces, such as blood vessels, intestines, or other hollow organs. Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula.
Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation.
A lucet is a tool used in cordmaking or braiding which is believed to date back to the Viking and Medieval periods, when it was used to create cords that were used on clothing, or to hang items from the belt. Lucet cord is square, strong, and slightly springy. It closely resembles knitted I-cord or the cord produced on a knitting spool. Lucet cord is formed by a series of loop like knots, and therefore will not unravel if cut. Unlike other braiding techniques such as kumihimo, finger-loop braiding or plaiting, where the threads are of a finite length, lucetted braids can be created without pre-measuring threads and so it is a technique suited for very long cords.
A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.
Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.
A fistulotomy is the surgical opening of a fistulous tract. They can be performed by excision of the tract and surrounding tissue, simple division of the tract, or gradual division and assisted drainage of the tract in a seton; a cord passed through the tract in a loop that is slowly tightened over a period of days or weeks.
A cable tie is a type of fastener, for holding items together, primarily electrical cables, and wires. Because of their low cost, ease of use, and binding strength, cable ties are ubiquitous, finding use in a wide range of other applications. Cable ties were first manufactured by Thomas & Betts under the brand name Ty-Rap.
The Albright special or Albright knot is a bend used in angling. It is a strong knot used to tie two different diameters of line together, for instance to tie monofilament to braid. The Albright is relatively smooth and passes through guides when required. Some anglers coat the knot with a rubber based cement to make it even smoother and more secure.
A Prusik is a friction hitch or knot used to attach a loop of cord around a rope, applied in climbing, canyoneering, mountaineering, caving, rope rescue, ziplining, and by arborists. The term Prusik is a name for both the loops of cord used to tie the hitch and the hitch itself, and the verb is "to prusik". More casually, the term is used for any friction hitch or device that can grab a rope. Due to the pronunciation, the word is often misspelled Prussik, Prussick, or Prussic.
Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).
Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and usually the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.
The bottle sling is a knot which can be used to create a handle for a glass or ceramic container with a slippery narrow neck, as long as the neck widens slightly near the top.
Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.
Goodsall's rule relates the external opening of an anal fistula to its internal opening. It states that if the perianal skin opening is posterior to the transverse anal line, the fistulous tract will open into the anal canal in the midline posteriorly, sometimes taking a curvilinear course. A perianal skin opening anterior to the transverse anal line is usually associated with a radial fistulous tract.
A barbed suture is a type of knotless surgical suture that has barbs on its surface. While suturing tissue, these barbs penetrate inside the tissue and lock them into place, eliminating the need for knots to tie the suture. Conventional sutures rely on a surgeon's ability to tie secure knots; barbed sutures provide a knotless alternative in some surgical situations. Barbed sutures are primarily used in cosmetic surgery.
Surgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, clinical pharmacists and veterinarians typically engage in suturing. Surgical knots are used to secure the sutures.
The knotless knot is a hitch knot used to attach an eyed fishing hook to fishing line while leaving a length of line hanging below the hook. The extra length of line can then be used as the hair of a hair rig.
A rectovestibular fistula, also referred to simply as a vestibular fistula, is an anorectal congenital disorder where an abnormal connection (fistula) exists between the rectum and the vulval vestibule of the female genitalia.
Surgical knots (ligatures) are the knots used to bind suture materials together while binding tissue in surgery. They are used in medical and veterinary settings.
A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. Urogenital fistulas vary in etiology. Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas.