How To Suture: Intro To Suturing Like a Surgeon

what's up you guys hey it's like good luck thanks for watching this video and this video is how to suture from a surgeon so this video is actually going to be a quick and dirty guide to how I suture this is the first video in a series of videos that are gonna teach you about suturing suture material instruments and all that good stuff I'd like to thank the folks at medical creations for supporting my channel by sponsoring this video as well as sending me this suture kit I'll be using today so what what you get here there's a nice little kit like that so what you get in this kit is a pair of forceps these are adsence a needle driver scalpel hemostat and scissors perfect right you also get a bunch of suture and one of these pads to suits wrong this is actually the old style pad this is the new path it's a great little kit if you want to learn and practice at home and the company is called medical creations so let's get to it I'm gonna pull out my heal driver here and my 4-step and some scissors and I've already opened a pack of extras at 4 o silk suture ring go over the types of sutures and the needles and all that stuff later but this one I want to get to the fun stuff which is suturing real quick let's talk about how to put the needle on the needle driver you wanted a about a 90 degree angle I sometimes do a little bit of an angle forward and that's just because my arms are triangulating the spot that I want to be it provides a 90 degree angle to the actual incision site so I do that sometimes second thing is how to hold the needle driver you want to put your thumb and your ring finger in the needle driver not the index here not the index or the middle finger the other way you can do it is the way I do is you you palm the needle driver like that and then that gives you more kind of like degrees of freedom because you can actually twist it like this but when you're starting out if you want do those two that's just fine now this is a pickup this is matsan pickup because it's got teeth this is specifically for skin so you do want to use the tooth pick up with skin so if I'm gonna try and close this incision right here I'm gonna take this needle driver and I want to put my finger as close to the tip of the needle driver as possible that actually makes the tip of the needle driver more steady and thus the needle more steady and the more things that you can rest your hands or elbows or wrists on the more steady you're gonna be I turn twist my wrist like this and I get the needle so it's going in about 90 degrees to the skin once it's in the depth that I like I twist my wrist okay and I see the needle come out you can close incisions with one or two bites and this one I'm gonna do two bites and notice what I'm gonna do here is pull the needle out just a little bit and then I'm gonna grab the needle exactly where I want to grab it for the next bite and that is about two-thirds back and at the tip of the needle driver two-thirds of the way back on the needle and now what I do is since I have this exactly where I want it this is what's good about palming is I pull it up slowly right I twist and I'm actually ready for the next bite there it is and notice I am palling which is why I can make this move once I put that in the second side I can go ahead and pull this out now I don't have to really hold the needle with my forceps the reason is because once you put the needle in the tissue the tissue should stay stable unless the patient's moving all around and second it'll stay stable if you hold it with the forceps so you want to hold the tissue actually with the forceps and not the needle with the force up and if you hold the tissue in place and let go the needle the needle should stay right in place and so then you can pick it up again now I can pull it out a little bit again I'm gonna grab it right where I want the needle driver to go for the next bite but I'm not gonna actually do next bite because we're gonna tie this and so here's another tip here a lot of students I see we have this long suture here a lot of people like pull this way high right you're gonna touch your face you're gonna hit somebody else's face if you're sitting real procedure you're gonna make it unsterile you're gonna lay this suture way out somewhere else that's not sterile so here's a little tip here what you can do is you just put your four-step right in here okay and you pull this along and you want to pull this suture down till you've got a few centimeters out there and the suture is sticking straight up that's gonna help later so then I'm gonna let go of the needle with this hand now the needle is not really that dangerous when it's not attached to something if it's attached to this you know you can poke somebody so as long as the needle is like dangling then typically it doesn't really cause any damage it won't poke through anything so what I do here is I grab usually a couple palm links or so and I'm also palming the forceps with my left hand okay this is for right-handers and all I do is just put the needle driver in between the tail and the length of the suture and the first one I usually do two wraps so this is pretty typical notice how much length I have a lot of students they make a mistake they go like this and then they don't have anything it's tight and it's gonna get caught in these jaws and when you open it up it gets caught or gets caught knees back here make a big nice loop and then when you bring it in okay I kind of brought around the back I start to make that loop and then look how big that loop is and then I make another loop and that's nice and big and then I grab this tip here which is sticking straight up for me and then I bring this across and I pull this through okay and then I lay this down and you pull it a little bit tight not too tight just approximating the tissue you don't want to strangulate the tissue to set this suture so it doesn't come out for my next throw I pull it like this snap it like that and even you can set it up in the air a little bit so that way it's not laying on the skin and then what I'm gonna do is I'm gonna put my needle driver between the long end and the tail again and I'm gonna make this big ol loop I don't care if it's too big but I don't want too small and then I'm gonna pull it through and this will then secure that now going back and forth and I'm gonna make a square knot so now I'm gonna go this way I didn't pull it up in the air all right bang um um back and forth okay I got maybe too much there but that is essentially simple suturing now this is a what we call a simple interrupted suture or not stitch I guess and there are lots of different types of sutures that knots and stitches and we're gonna go over those in my other videos but I'm just going to do a couple more for you to watch and I'll point out a few other things so I palm it I can get more rotation when I Palma that's why I do that do your attendings might not like that at the beginning and so he might have to put your thumb and ring finger in there but practice Paul me at home okay and now I'm gonna do just one bite cross here I'm gonna turn it up there we go okay it didn't come out very much there and I don't have to hold this tissue with with this thing but you might have to hold the tissue to keep the needle in the same spot so if I hold the tissue with this I pull this across I steady this side of the tissue this needles not going anywhere then I'm gonna pull it out of just a tap so I'm gonna go and I'm right about there because two-thirds of the way back is where I want to grab it right there okay and I'm gonna pull it through and this house what happens at your palm is sometimes try to be fancy and I can do this maneuver this is a long suture typically you don't use suture this long but it's good that comes in this kit because you can practice more so the other thing that you want to do is really you don't want to touch the needle too much because the more you touch it the more chance you have to poke yourself so what you can do is actually grab this suture here or by your finger and raise it up and then set the needle in a place that you think you can pick it up in fact you can just grasp it a little bit not clamp it all the way down okay and then turn it a little bit if you want to and so this is going to be a figure eight suture stitch I'm going to two of them right next to each other this is used for a lot of time for ligating a blood vessel put the blood vessel right middle there I also use this for my abdominal incisions that poor sites for like a 12 millimeter port for a laparoscope so it's called figure eight because we're gonna make an eight out of it see that looks like an eight almost more like an X but you know what I'm talking about snap this there pull it up in the air put the needle driving in between the two I already did what I did too right okay well snap it down with silk you don't necessarily need to do a lot of throws typically most people say three four silk and four four Vicryl I do usually four and five extra safety I'm doing just some more just to what so you can watch and you don't have to go back and forth with silk because it's a poly filament suture which I'm gonna talk about in the other videos as well you can if you want so okay that's a lot you don't need that many for reals okay okay that is the basics of suturing now you know how to do it I'm gonna talk about hand tying and different types of sutures and things like that and the other videos so go check out those videos and I'll see you in the next one anyway that is how to suture from a surgeon that's the quick and dirty and I'll see in the next video don't forget to subscribe like share comment below thank you guys so much for watching I'll see you the next one

Channel: Buck Parker, M.D.

Views: 2,158,811

Rating: 4.9382329 out of 5

Keywords: board certified surgeon, general surgeon, trauma surgeon, surgeon, med school, med student, medical school, medical student, resident, residency, health care, medical, doctor advice, medical advice, student advice, job advice, nurse, doctor, medical student advice, job tips, career tips, student tips, dr. buck, buck parker, suture tutorial, suture knot tying, sutures, suture techniques, suture kit, suture types

Id: NnKdmjX5pWU

Length: 10min 10sec (610 seconds)

Published: Tue Oct 08 2019