How to Suture Like a Surgeon | Intro to Suturing

what's up guys my name is dr. antonia webb orthopedic spine surgery fellow in this video and over the course of the next few videos we're going to be talking about suturing how to suture like a surgeon we will go over the different types of sutures the different instrument ties how to throw surgical knots what is suturing and some other tips for you guys I want to thank these sponsors of this video art idea and the people over at suture kit comm for sponsoring this video make sure you check them out in the description for some discounts for you guys so suture practice kits is something that I wish I would have had as a medical student and whether you are in nursing school and school to be a EMT or paramedic medical school resident this suture kit or any other suture kit out there is something that you can use to practice at home at work or when you're away from the hospital when I was in medical school one plastic surgeon recommended to me that I used my steering wheel at every red light and I throw a surgical knots and I did that for a number of years until I got comfortable throwing surgical knots by myself so even if you're starting off slow one person versus another person everyone gets to that same level throughout your medical training it takes a lot of practice you just have to practice at it and this kid is something that is really essential if you want to become a surgeon emergency medicine doctor dermatologist or whatever specialty that you go into I think it's important to practice so this suture kit practice kit here is something that comes together in a really convenient box there's 25 pieces on the inside of this and there are multiple different types of sutures there's a nylon there's a silk and these are all the types of sutures that we use kind of in the hospital and surgery or in the emergency room one of the cool things is that it comes with this make life skin here so this product is designed to replicate the natural skin it has three layers to it as a fat layer has a skin layer as well as a dermis and epidermis layer inside the package here also is the instruments number one this is a needle driver here this is a instrument that we use in surgery one of the most important things to know about this is palming the needle driver some people palm the needle driver with their thumb inside this little circle here but I think it's actually better to Palm it with your palm that way when you're handing off instruments to the surgical tech or to another surgeon you can easily do that if you have your fingers or your thumb and this circle here is actually harder to take your thumb out and then hand it what I did as a medical student was I walked around the house I got one of these from the hospital and I opened and closed this all throughout the day and then came more comfortable with doing that the second instrument that's in here is actually a hemostat this is when we're grabbing certain tissues if we have a suture that we need to grab that's deep in the wound we can use this to grab that particular object if we needed to grab a vessel we can use it to grab a vessel and the same thing you want to use your palm to open and close it the third thing that's in this kid is a blades they actually come with different blades that you can use to cut the skin this blade here can be attached to this instrument you have to be very careful this is pretty sharp so this goes on like this here and to be careful you want to lock it in place so if we needed to cut the skin or hopefully not cut anybody this is a pretty sharp so just be careful but this is a knife or a blade there's different sizes this is a eleven blade they have a 15 blade which is smaller but this is a blade that we use in surgery here the next instrument that we have is the Addison pickup this is a instrument that we use to grab tissue or to grab the suture itself it has little teeth at the end here and you basically hold it like a pencil when I'm suturing this is how I hold the ATS and pick up the last instrument that we have here and the kit is a pair of scissors and this is a pretty smaller size scissors that we would use in surgery but it's great for practicing after you tie your suture you want to be able to cut it and then move on to the next suture so so the two big types of sutures are zorbel sutures and non-absorbable sutures absorbable sutures are ones that don't need to be taken out from the patient say for instance the patient has laceration on their arm and then some deep sutures are placed these sutures can be like Vicryl or monochrome anything with a krill on it that's the way I kind of remember it our verbal sutures and these don't need to be removed from the body conversely a NHANES overbill suture is like nylon or silk these are sutures that do not absorb they need to be taken out of the body or sometimes we use them to ligate vessels so this is a non absorbable suture nylon silk is a non-absorbable suture and then Vicryl is a zorb herbal suture which means we can place these in the patient and over time the body will absorb this suture if we talk about these sizes of sutures it's conversely related to the number so a 700 suture or 800 suture is actually a very small suture and a 100 or a 200 or 300 the Tzar fairly large sutures so this is a number one it's a fairly large suture we use this to close the fasciae or any deep the layers of the skin and this is a five-o as well as a four oh so these are smaller sutures in this one oh Michael here so this comes in the kit and it's actually good because it comes with different size and different types of wounds in the emergency room as well as in surgery you may have incisions or lacerations that go in different directions and you should be comfortable and be able to suture whether the laceration is this way or this way so when you pick up your needle driver as well as your ATS and pick up usually I hold it like I said in my palm and then we have our suture here you want to pick up your suture kind of at the two-thirds of the way back and I like my suture to be turned this way here so not ninety degrees but a little bit more than that so I think it's easier to come in and out of the skin that way you don't want your needle driver to be very close because when you're trying to grab skin here this will not allow you to pick up much tissue and you don't want it too far back towards the suturing aspect of the needle so about two-thirds of the way back and you see I have my needle driver and my palm here my Adson pickup and my left hand I'm holding it like a pencil here the first thing we're going to do is throw a simple interrupted suture this suture should be placed a few millimeters from the skin edge here so I'm going to use my Adson pickup to lift up the skin here and usually about ninety degrees a few millimeters away from the skin edge you can take it and two bites which means that you go through the middle first and then you throw another one on the opposite side or you can take it in one bite once you have your suture and your stitch thrown you want to pull it all the way so that this tail here is not too long and you're still able to tie this suture so I usually leave maybe a couple centimeters kind of out this way because if you leave too much suture this way you're going to be wasting suture so I think it's important to just leave a little tail the first thing you want to do is to place your needle driver in between your two suture kind of edges right in the middle and what we're going to do is wrap that around the needle driver twice and then grab that smaller edge so we'll do that again once twice and grab that small edge and then you want to pull your hand in the opposite direction so we wrap the suture around the needle driver twice the second time you don't have to wrap it twice we can just do it once so once and then you're carrying ear right hand and the opposite direction to lay down that knot now we're going to do the opposite way to lock this knot we're going to go not in the middle here just under the longer suture and wrap it around once and then go the opposite direction so most sutures you don't have to throw multiple knots but some sutures this knot can easily slide so you want to throw multiple knots so we're going to throw a couple more so that you guys can to actually see what I'm doing needle drive it right in the middle wrap it around twice and then grab that edge and then pull it through we're gonna do that again the second time you just need to throw it once and then the third time it's not here it's just the opposite wrap it around grab the edge and then that's your knot there so that's a simple interrupted suture so we're going to try that suture again a simple suture we have our needle driver with the needle that's about two-thirds of the way back then our Adson pickup you want to grab the skin edge a couple millimeters away from the laceration or wound 90 degrees and at this time we're actually going to take it in one bite sometimes I take it in two bites depending on the size of the wound other times I take it in one bite you want to pull your needle kind of through and then curve it in the direction of the needle you don't want to pull straight up you want to pull it so it comes out in the direction of the needle as soon as you pull it through the skin here you should be able to grab the needle but you have to be careful this needle sharp so we're going to pull this through we want to make sure that this edge here of the suture is not too long the needle driver goes right in the middle and then we're going to wrap it twice and then grab this suture and then move our right hand to the left as you can see the knot going down we're going to do that again the second time you just do it once right hand goes to the right this time and then the third time we'll lock it it's not here it's here around pick that edge up and then lay that down so that's a simple knot right in the middle we'll do a couple more you do it twice move our right hand to the left right in the middle again only one time this time move our right hand to the right and then the third time to lock the knot you want to put it on the outside wrap it around grab it and move your right hand to the right a couple other tips when handling your needle you want to make sure that you protect it like this here so when you hand this back to the surgical tech the needle is protected and it doesn't stab anyone or poke anyone so you never want to hand back the needle to your surgical tech or to another person like this here you always want to protect that needle be careful just touching the edge of the needle you can get poked protect your needle whenever I hand this back to the surgical tech I always let them know hey there's a needle that's on the table you communicate with the surgical team the rest of the surgeons the the surgical assists that there's a needle that is on the surgical table so I want to thank the sponsors of this video over at art Asia and suture kit comm for sponsoring this video make sure you check them out this is a series of four videos on how to suture like a surgeon I hope you guys learned something and we'll see you in the next one

Channel: Antonio J. Webb, M.D.

Views: 188,992

Keywords: how to suture like a surgeon, how to suture left handed, suture knot tying, suture tutorial, how to suture, suture techniques, surgical knot, vertical mattress suture, subcuticular suture, learn to suture, simple suture, figure of 8 suture, simple interrupted suture, simple continuous suture, simple running suture, figure of 8 suture removal, figure of 8 suture bleeding vessel, figure of 8 suture steps

Id: _jbG59gSk3E

Length: 14min 3sec (843 seconds)

Published: Mon Feb 17 2020