REAL SURGEON PERFORMS SURGERY ON AN ORANGE | Orthopedic Surgeon Explains How To Suture Like A Boss

Chris orthopedic surgeon and sports medicine physician and today I'm on an arm row what are you talking about man why do I want to do that let me tell you what we do our medical training we have to learn how to suture on humans and we need to do that without actually suturing on humans because you got to learn how to hold your instruments you got to learn how much pressure to apply and all those kinds of things I guess through experience we've found there are a number of things that we can use as close facsimile or close representatives of humans skin into the texture of human bodies few of those things that we use are oranges the pig's feet don't have any of those here today but if you like this video you should have let me know in the comment section and I'll be sure to show you that we like oranges in particular because the amount of pressure that you have to put on skin to either cut it with a scalpel or to pass the needle through the flesh is roughly equivalent to what it's like for you to do that to human tissue so you can go through a lot of oranges when they're practicing and not worry that you're doing something that's very expensive doing something that is dangerous or harmful to somebody doing something that's gonna be bloody or create a lot of mess other than a little bit of spilled orange juice yeah I got it so I have here an assortment of instruments that I might typically use if I were doing a small procedure not all of them I'm gonna use today but I'll show you what those things are the first thing if we're going to operate on something we're gonna have a knife or a scalpel this is called an 11 blade well that refers to the shape of the blade at least in orthopedics we use 15 blades which is a very small rounded tip blade we use number 10 blades which are rounded but very large those are our primary skin scalpels and then we use 11 blades when we want to make very small holes such as if we're doing just like arthroscopy so then we also have what we call snaps these are hemostats and these are very fine hemostats they come to a small plate there you can use them to grasp and hold things sometimes we'll use them to grab sutures this is called a needle driver it kind of looks like the snap that you can see that end is straight and it's not curved but this is used to hold sutures usually we will hold it with thumb in one hole our middle finger in the other hole and we use our index finger on the shaft to help control it but there are a number of different ways you can hold it with one in the fourth you can not put anything in that other one and you can just use your thumb on the edge of it so there's a number two right there we have scissors here these are curved pair of scissors and these are relatively fine scissors these are called Metzenbaum scissors very slim dissection scissors which have a curved point then we have our forceps there are a number of different kinds of forceps these are relatively fine forceps they're not micro forceps people use when they're operating on vasculature or nerve tissues these are called Adsense they're serrated in there so you can have tea and you can have fine forceps without that helps us to grasp fine delicate tissue and grass Camille and then we have the suture we have many different sizes so this is called a 300 suture and this is a relatively common skin suture that we use for closure what we call a monofilament suture which means that it is one single filament one single strand as opposed to a poly filament suture which is many strands woven together like a rope this is called prolene which is basically a type of plastic so this is a non-absorbable suture so when we put this suture in this is a type of suture you need to have cut it as opposed to something like catgut which is actually material that we use for sutures that is something that is absorbable and so those do not need to be taken out this is not absorbable and it is typically used on the surface of the skin first things first I gotta get my my surgical site red orange simple orange so basically what I'm going to do is I'm going to make a couple incisions in the orange and then we're gonna go and sew this thing back up together so when we're cutting through you have to learn how hard to press on the tissue so that only comes with practice when you first learn to cut most people tend not to press hard enough and they tend to just kind of go on the edge and then you got to make a whole bunch of passes and you don't want to do that you don't want to make an incision where you have a whole bunch of marks you want to make one straight line and the tissue let me just do one more here and what I'll do is I'll intersect these lines a little bit so now we've made some incisions always practice safety so we're gonna protect our blade although generally when we are in the or we don't use these type of disposable blades we use reusable handles that can be sterilized and we put single-use blades onto those handles most of the places actually now use what are called safety blades so they have a retractable cover which you can place back over the blade put my hand out Alaska scalpel they'll put the scalpel in my hand blade first so then I'll start working when I'm handing the scalpel back because I need to pay attention to what I'm doing I will hand the scalpel back knife up hand the scalpel back usually if it has a retractable cover on it I'll put the cover on so that it's see and then I will hand it back while I'm concentrating on what I'm concentrating them so they know that when they get it back it's safe they're not going to cut themselves so we've got the knife there so now there's a number of ways where you can detect this but basically I'm going to use my snap here just as a tool to do some blunt dissection just to get the edge started and then we use our dissection scissors the Betts and I'm going to try to dissect the peel off to the orange without damaging the tissue underneath too much so this is kind of like the the layers of the skin in a human so you have the outer rind of the peel which is kind of like the epidermis or your outer layer of skin and then you have this layer of white underneath which is like the dermis of the skin and underneath that you have the fashio and the muscle tissue do it once more over on this side we use the tips of the dissection scissors to do what we call blunt dissection we find a plain the desired area that we want we kind of gently spread the blades and then we can dissect the tissue so again you can see here we have the epidermis or the outer layer of the skin the dermis underneath and then we have the fascia which this white stuff would be covering the muscle tissue we were gonna go much deeper than that if we're operating on an internal structure then obviously we would carry out our dissection down through the layer of the muscle tissue elevating that as appropriate cauterizing or live eating or tying off any blood vessels that we come across so that we minimize bleeding sometimes to also help with minimizing bleeding we would put on what's called a tourniquet and so for those who don't know what that is just think of a big blood pressure cuff so we would use that to help control the blood flow in the area where we're working but obviously we can only use Turner keys on the extremities so arms hands legs and feet if you're working on the core you cannot do that and then you have to have more stringent or more strict hemostasis so hemostasis just refers to the control over bleeding and so we would either do that by tying off the blood vessel or we would cauterize so apply an electric current to the blood vessel where it was open or cut you would burn the tip and that would basically heat up the tip and cause the protein of the tip to coagulate and basically block off the cold blood having said all of that we now have our two incisions as you can see in the orange and obviously we want to close this guy up because we don't want to have any infections so what we're gonna do is we're gonna take out our suture we need our force X and we need our needs driver we're gonna take out the needle this is a medium sized needle there's two different types of needles roughly two different types of needles and one is called a taper and the other one's called a cutting needle we use those different needles that at different times now we're going to sell these incisions back on it and there's a number of ways to do this we always want to try to re-approach meet the skin to where it was before it was open so one of the things that we do before we actually cut the skin knows we will mark on our incision so for example for our making an incision like this I would mark the incision then I would also mark the ends of the incision and I would probably mark some hatch marks across the incision or some lines across the incision that tells me when I cut this I know that these two spots go together I know that these two spots school together I know that this here goes together and that goes together so that when we finish our incision we try to recreate that we've already made our incisions just for the purposes of teaching put these lines across the first thing that I'm going to do is I'm going to sew this point together because I know that that point goes there I said to you that our needles are curved and the reason why is because we need to be able to take the needles in and out of the flesh and the easiest way to do that is if the needles are curved when we bring the needles in we don't just push the needle we actually rotate our wrist because the needle is curved so they rotate the wrist around first thing I'm gonna do is I'm going to do this first suture here because this is going to secure the corner and I know that the the corner is secure there time my knots so there are a number of ways to tie knots this is called a stick tie where as you can tie by hand that corner is solid there so I've done that suture grab my suture because this is an orange and this is not someone's flesh it's gonna be rolling around so normally I would try not to touch my needle although we we're gonna have sterile gloves on to do everything with our instruments that means I hired my instruments I grabbed my suture with my instruments and manipulate a suture with the instrument because we have the orange and it rolls it makes it a little bit more difficult for me to do that so I have my needle here I'm gonna hold the needle in such a way the needle is dangling here over my surgical field and then I'm going to tie the knot so obviously we tie the knots with our instruments for the stick tie we do two throws first and then we grab the suture we always want to make sure that our knots are square so if you look at the knot right now you can see it kind of looks all jumbled up but if I rotate my hands you can see that now the knot has come flat so this is what we mean when we say we're going to tie the knot square so that when I do that the suture lays down nice and flat and it's easy for me to grasp so then I'm gonna do another loop or a single throw come back the other way again the knot is flat and then I want to make sure that both of those first two passes of the suture have been in the same direction now I'm going to do one suture throw in the opposite direction so that I can lock the suture because what I did those first two throws the knot could still slide but if I lock the suture then the knot will no longer slide when we tie our dots we always want to try and leave long enough tails that whoever is going to be taking out these sutures is going to be able to grasp the suture if you ever had just put in and the sutures are difficult to take out one of the reasons why that it might be difficult to take out is because whomever was cutting the sutures usually when the surgeon is sewing it's not him who's cutting it maybe the surgical assistant or the scrub tech or the scrub nurse they have I'm not sure which one to cut here so we always gotta remind them to cut the sutures and an appropriate length but this is of course for sutures that are going on the outside of the body these are sutures that we're going to cut up if there were sutures on the inside of the body I'll often say to people cut it short which means cut it just above the knots no tails so pass another throw here so again it's rotating you try to make sure that we can control control our instruments so you try to move everything as little as possible and keep it close to the surface that you're working on so again you can see everything's twisted up there but now they're not lays flat to square and then one the opposite direction so people who are watching so that one's a little bit loose there so people who are watching might be saying well how do I know that I've done them in opposite direction well let me show you okay so let's begin get our suture pass through grab the suture almost lost it nope tail the other end I'm gonna put the needle driver in between roll around twice okay turn my hands to make sure the knot is square good lay it down now the tail is on the other side but if I want to make sure that I'm tying this next teacher in the same direction I keep the needle driver in between the tail and then it's a one direction make sure it's square Poole now I want to do this last one in an opposite direction so rather than putting the needle driver inside between the two ends I'm going to put it outside one end do my loop come back grab the suture and bang I know I have a locked knot with two throws in one direction and a single throw in the other direction so I won't talk too much I'll just sew these up running out of suture here so pretty soon I'm gonna have to ask my scrub nurse for a new suture to do my other incision people always wonder how much suture do we need to suture with and as you can see we don't really have that much left and it's always kind of a contest with us to see just how little suture we can suture it how little suture do we need to tie knots oh but just because I want to challenge myself and how much I got left here okay I got five centimeters left and because there's just a little bit of opening here we're going to see if I can do one more not the suture boom-shaka-laka so there you go so that's one that is some okay always protect your needle make sure the needle is safe you don't want anybody to get poked so now I'm going to show you a little magic so I showed you guys how to suture so now I'm gonna show you hand ties and I'm gonna show you hand ties when you have something you have the needle driver in one hand and you only have one hand to tie knots with so now I have a finer needle okay and or a finer suture this is a fiber which is a much smaller much finer needle so I'm just going to do a couple of passes with this teacher and I just want to do that so that you can see what happens when we have to sew up and we're not doing stick ties so I'm going to pass a throw of the suture here it's a much smaller needle so we have to take a much shallower bite [Music] I grabbed that I'm going to because I'm going to be tying with my hands I want to protect the needle here so I want to make sure that the needle is safe so I put the point back here grab the rest of the needle so that's locked so I know that this is saya so now I'm holding the suture here got the one end of the suture and I'm going to tie knots with my one hand okay so so we'll be tying the knots we want to do knots in both directions what and you can see because it's a very fine suture and actually pulled out of the tissue and so let's cut the knot off I'm going to try that again see if we can take a bit of a deeper bite here does that ever happen what not get pulled out you know like you pull through the skin oh yeah especially patients who have what we call very friable skin so elderly patients patients who have very very poor protein intake don't have a lot of albumin those people very it's very common for for sutures to pull out again we try to make sure that they're not square now usually if we're going to use suture this fine we wouldn't be tying that by hand you would usually be doing instrument ties but just for the purpose of this I'm going to show you guys so there's four throws usually for what I'm doing I'm gonna do three throws if you're doing ties on blood vessels or what nots things that like you don't want in any way shape or form you're not to come off you might do more [Music] the tip always pointing into the scissors yes okay eight I'm not it's not enough no no I wanted to be really secure right it's enough just for good measure ten you can see it's making like a pile of knots we call that a not stack actually yeah it's actually what's called a not stack because the stack of knots obviously okay Wow you would never do 1000 your knots that would have four oh there is my orange I've operated on orange today fortunately this orange will go on to make orange juice on another day if you're new to channel be sure to subscribe hit the notifications down so that you can get notified when we post new content if you're a returning member of the interns army you know what to do go hit the like button and share this video with a friend if you'd like to see me operate our things other than orange like say for example I don't know pig's foot grape something like that be sure to let me know what you'd like to see in the comments and I'll try to accommodate you and as always that's been a word or maybe that's been the suture from dr. Chris not snore every day [Music] [Music] [Music]

Channel: Dr. Chris Raynor | Not Your Everyday Ortho

Views: 75,128

Keywords: performs surgery on an orange, performs surgery, surgery on an orange, orange surgery, orange, doctor performs surgery, real surgeon, dr chris raynor, stablekneez, doctor performs surgery on a grape, surgeon, surgery, dr chris, surgical skills, they did surgery on a grape, surgery on a grape, grape surgery, grape, surgery grape, surgery on grape, grape surgery video, doctor reacts, how to suture, how to, medical student, med student, suture tutorial, suture techniques, meded

Id: cMUBWG74S3U

Length: 23min 2sec (1382 seconds)

Published: Fri Mar 08 2019