Suturing Techniques

Question: Suturing Techniques? Regarding proper suture techniques, is it correct to pass the needle completely through the proximal edge of the wound first, then the distal edge? Or do you just go through the proximal and then the distal edges in one motion? Just for the proper knowledge.

Answer: It depends on the location and size of the laceration or wound. It also depends on the skill of the suterer. Why do you ask?

Question: What material around the home can I use to practice my suturing technique? Calling all fellow medical students, nurses, doctors, surgeons, dentists, and anyone else handy with a needle holder, forceps, and some Ethilon! Any tips for what material I can use to practice suturing at home? I have the equipment and suture packs, but I'm in need of something that feels kinda fleshy! I've been told banana skins and orange peel, but first one seems too soft, and second too hard. My gf suggests suturing our Thanksgiving turkey after we stuff it good - which sounds like a great idea to me. Any other suggestions for less festive times of the year? :)

Answer: The quality of the material is completely inconsequential in regard to the practice of suturing. The most important aspect of placing sutures is proper tissue handling, instrument and tying technique, relative to the situation at hand. If one is suturing into strong tissue such as abdominal muscle fascia with a #1 vicryl, then a completely different amount of force is applied than if one is using a 5-0 prolene to close an opening in the vena cava. The placement of the needle through the tissue, however, and the attention paid to avoiding lateral stresses to the tissue by "following the curve of the needle" is key. When you tie down the knot, whether using instrument tying technique or hand tying, make certain that you snug the knot firmly but without over-cinching. "Approximate, don't strangulate!" is a slogan of wisdom now, just as it has always been. Bring the knot TO the tissue, and do not tension the tissue by pulling on the suture as the knot is tightened. Here are some illustrative exercises: (I'm assuming you've been properly instructed in how to hand-tie suture using two-handed and one-handed technique, as well as instrument tie.) 1) Using a rubber exam glove, place a finger of the glove under a small weight on the table top. Use a small book, or for more challenge, use less weight such as a cell phone or even just a pen. With foreceps and a needle driver, gently place a stitch into the glove. For glove material, I recommend a 3-0 silk. Now, tie the suture down firmly without pulling the glove out from under the weight. Once you have 3 or 4 knot throws, pick up the glove and look at your knot very closely. Did it cinch tight? Is it an "air knot" ? Use a tine of your foreceps and worm it into the suture below the knot, if you can. Can you pull the suture open, showing that your knot can slide? If you do this exercise correctly, you can show that your throws are "going down square" because the knot won't slide. 2) Take a styrofoam coffee cup and poke a hole in the side, near the bottom. Worm the finger of a rubber exam glove from the outside into the cup so that as you look down into the cup, you see the finger protruding into the space. Grasp the tip of the glove finger with a pick-up and clamp across it with a right-angle Mixter clamp. Now, tie off around the finger using a free (silk) tie. Use whatever size you want, but again I recommend 3-0. When you're done, remove the glove from the cup and blow it up like a balloon. Can you prevent air from travelling distally into the finger tip? Is your tie-off "air tight"? 3) For giggles, peel an orange in one piece. Start at one end, gently tearing a large circle around the stem insertion point, but then continue down the orange as a spiral till you can lift off the far end as another circle. Now, sew the peel back together with a running subcuticular stitch. I recommend 3-0 vicryl on the SH needle. Don't use a pop-off needle. The secret is that you don't need to knot the suture at the beginning, just anchor the start by doing a couple of needle passes through the white underside, then when you run out of suture, cut off the needle and just start a new one. No need to knot! If you do this well, you can make the orange look PERFECTLY intact, but it's tougher than it sounds. The orange peel will show off any step-offs from asymmetric suture placements from one side of the gap to the other, and if your exits and entries aren't close to perfectly aligned across the gap, then when you gently cinch it down, the gap will gape. If you over-cinch in order to try to crush the flaws out of your suture line, the tissue will tear. 4) With a sharp knife (perhaps a scalpel), cut a grape in half. Now sew it back together with at least 4 interrupted sutures. I don't care how you hold the grape to do this, and the suture choice is an exercise left to you. There are two modes of failure. One is if your suture rips through. The other is if you tie so losely that when you pick up the grape by one half, the other half sags or shifts. The bottom line is that any practice is good practice as long as you practice good technique! If you start developing bad habits now, then you're going to be fighting to rid yourself of ingrained error. Work with surgeons to critique your skills, and remember, do as they SAY, not as they do... many surgeons will bend the rules a bit here and there when they know that the situation isn't critical. You, on the other hand, are in training. As such, rule bending isn't something you're priveleged to do! I hope that helps. Feel free to contact me if you have questions.

Question: Does anyone know where to find "Surgical Suturing Techniques" on the web (or types of surgical knots)?

Answer: Here ya go...it's all right here: http://www.bumc.bu.edu/Dept/Content.aspx…

Question: what suturing technique is used in placing a jackson-pratt drain? how about in closing a mastectomy procedure? thanks!

Answer: JP drain would be more superficial, as it would be removed. Mastectomy is closed in layers, even nicer closure if plastic surgeon does it with running suture/prolene maybe someone else may have different experience or more specific answers for you.

Question: What is the technique of Interrupted circular suture: bleeding control during cesarean ?

Answer: I have no idea, but when I had my c-section 5 months ago. I was glued back togther. The nurse said It was like a strong super glue. Thankfully, I healed back perfectly except for the scar.

Question: types of sutures technique in dental surgery. pls find.?

Answer: Putting "dental suture" in a Google Image search produced 113 results. Or, go to http://www.us.elsevierhealth.com/special… for books on Oral Surgery that would include suture techniques.

Question: My dog was recently spayed. The suture technique used is two large "x" shapes. What was the purpose of this? I don't understand why a typical suture wasn't used, I'm taking her to the vet in the A.M, however I am actually trying to figure out if I have something to go in there with besides, "I don't like the sutures you used" I feel like the suture used is preventing proper healing... She's getting a scab like consistency on the suture line and it's accumulating underneath the "x" shaped sutures. it also doesn't look like the two sections of her skin meet, one is overlapping the other and it seems like it won't heal properly. I took her to the vet 4 days after having it done and the technician said she was fine and just to keep her from licking at it, I have had her under 24/7 surveilance and if she's not being watched she has an E-collar properly fitted. My main question is, is this suture commonly used? Has anyone seen this suture type used on their own pets? Is the flap suppose to be overlapping or should the skin have met so they could heal?

Answer: tHE scab, means it healing up, The scab should be under the stitches if they are normal white ones, if they are clear, then quite often the scab will be over these stitches-The clear ones are normally desolving stitches-but sometimes, they don't actually desolve-they fall out instead. If it didn't scab, then its not heeling. It completely normal for the suture line to scab up. it would be bad if it wasn't scabbing up at all, if no scab was there, it mean it wasn't heeling at all! its take at least 2 weeks before the stithches can come out!! Maybe it a way of saving money. Less Stitches, means less cost, is my only thinking behind it.

Question: what equipment do I need for a suture set and what is the wrapping technique for autoclaving?

Answer: Dare I ask what youa re doing? check the pdf

Question: Blepharoplasty: Double-eyelid operation in HCM City (Vietnam)? Blepharoplasty is a Double-eyelid operation that involves in Laser and No-Cut Suture Technique. I just want to know if there's any in HCM City that does this operation. So if you know, please provide their company name, address, phone number and maybe, if possible the reviews about them and what they offer. Btw, is it allowable for teenage patients aged 15 to undergo this operation and how much it would cost in USD or AUD. Thanks. I'll appreciate your answers. <3

Answer: Viet-My Institute of Aesthetic Plastic Surgery 93 Phan Xich Long, Ward 2, Phu Nhuan District, HoChi Minh City, Vietnam Phone/Fax: +84-8-39955683 http://www.vcosmeticsurgery.com drhieplc@gmail.com Saigon Hospital Of Cosmetic Surgery 97B Nguyen Du, Ben Thanh ward, District 1, Ho Chi Minh City, Viet Nam Tel: (84.8)-3829-1342 or 3829-2571 Fax: (84.8)-3823-9461 Website: www.bacsicuong.com or www.thammysaigon.com Email: nxcuong@yahoo About US $ 300. All cosmetic surgeries performed on minors (people under 21) require a written authorization by the minor's parent(s) or legal guardians.

Question: Which is the best surgery for an 8 month old Whippet with a torn cruciate? Knowing that a Whippet is a very active dog...which surgery would work best for her TPLO or Suture technique? I have been told TPLO by one surgeon and Suture by the others. I also have been told by 2 vets to wait and by the other 2 to get this done right away. My feeling is that with her being a dog that will be under 25 lbs the suture technique should work and I also feel that it should be done right away. I would appreciate your expert opinion. Thank you

Answer: My husband and and I have had cruciate surgery done on two of our dogs over the years (both around 30-40 pounds). On both dogs we had the TPLO surgery done, and both were a complete success. I would recommend the TPLO, especially on a very active dog. You have to follow all the instructions during the recovery (cage rest, leash walking, etc) but once they are healed, they are healed. With the suture technique, on an active dog, there is a good chance of them breaking the sutures and/or re-injuring the leg, and then you are back where you started. The TPLO costs more, but the long term results are much better in my opinion. Good luck.