Basic Suturing Techniques

hi this is alir W with Cape Town emergency medicine today talking about basic suturing techniques and showing you three example sutures often used in suturing skin wounds first let's talk about the equipment that is required the minimum equipment you will need to suure a wound is suture material there are many different kinds of suture material available on the market and a full discussion of their pren cons are outside the scope of this demonstration today we will use a nylon monofilament suture you will also need a needle holder a pair of scissors and either toothed or non-toothed forceps depending on what's available you will need local anesthetic to anesthetize the wound some GES and a cleaning solution after explaining the procedure to the patient Dawn universal precautions and proceed gently cleaning the external surface of the wound once this has been done inject local anesthetic along the wound edges approaching the wound from the wound side itself and not injecting through the skin make sure that the entire wound is antiz along both its lengths from edge to edge once the wound has been anodized safely dispose of your shell and allow the local anesthetic enough time to work after an appropriate passage of time test the wound Edge and confirm that your anesthesia has been successful it is now appropriate to clean the wound a bit more vigorously including the inside of the wound and to rinse or irrigate it out if there's any or material this should now cause less discomfort or pain to the patient once the skin has been prepared proceed to suturing in this case we're going to use a nylon monofilament suture open your suture reveal the needle and grab the needle with your needle holder hold the needle about a third to A4 from the back of the needle on the flat surface with the tip of the needle holder this allows for an easy rotating motion of the wrist to take the needle through the skip when suturing a wound we suggest starting in the middle and then progressively halfing the gaps in between to ensure even distribution of sutures for a simple interrupted suture insert the needle at 90° to the skin and with a rotating motion of the wrist simply twist the needle through you could also insert on the one end come out the middle of the wound and insert again pull the suture material through leing just enough to suture there are many ways to tie an instrument not one way is the following turn it twice around the instrument grab the suture and pull it across the wound as such only enough Force should be applied to approximate the wound inches and avoid excessive tension across the wound now rotate the material in the opposite direction around your instrument grab the tip and tie another knot finally two in the direction the same as before and complete your knot seat the knot over one of the entry edges and neatly trim the edges of your suturing material another useful suture to use is a vertical mattress suture a vertical mattress suture takes a bite of tissue that is slightly further and deeper than a simple interrupted suture initially as an initial throw reverse the direction of the needle on your instrument so that you can come back back across the wound to come back across the wound go shallow and close to the wound Edge grabbing only a small piece of skin pull the suure material through until you have just enough to tie the knots not same as before one two put it across one put it across and finally one two and put it across you will notice that the suture lies to the side of the wound with no material Crossing it and that it results in slight ersion of the wound edges which may Pro promote wound healing finally I will show you a pulley suture which is a variation on a vertical matter suture and is an extremely useful suture when trying to suture wounds that gape widely or under a lot of tension position the needle correctly and start off with a vertical mattress suture as shown before deep and far deep and far switch the position of the needle and now come back close and shallow and again close and shallow if you were to complete the suture now this would be a simple vertical mattress suture instead though pass your needle through this preserved proximal skin Loop represented on the vertical mattress suture as that pass it through and now tie the knots two and pull one and pull two and pull turn the edges of the switching material by passing the needle back through the proximal skin Loop you have created a pull effect allowing the physics of this configuration to spread the tension across the wound much more efficiently and close wounds even under a lot of tension much more efficiently one potential use for a pulley suture is to do the initial harving or maybe even the second harving and then fill in the rest with simple interrupted sutures in a widely gaping or high tension room and that's it thank you very much

Channel: EM CapeTown

Views: 895,582

Keywords: suture, suturing, techniques, basics

Id: 5Sfz8EmCpio

Length: 7min 37sec (457 seconds)

Published: Fri Feb 01 2013