How to Suture Like a Surgeon: Subcuticular Suturing
TLDRIn this informative video, the presenter offers a detailed tutorial on performing a subcuticular (sub-q) suture, a technique used for closing skin incisions to achieve a neat and professional result. The video is sponsored by Medical Creations, who provide a suture kit that includes essential tools such as a needle driver, scissors, scalpel, and hemostat, along with a suture pad and various sutures for practice. The presenter uses 3-0 nylon suture, which is not typically used for subcuticular sutures but is chosen for visibility. The tutorial covers the proper handling of the needle driver, the importance of suturing in the dermis layer, and the correct way to tie knots to ensure the knot remains hidden and the skin closes smoothly. The presenter also demonstrates the backhand technique and provides tips on avoiding common mistakes, such as ensuring both ends of the suture come out on the same side and not pulling the suture too tight. The video concludes with a demonstration of a running suture for longer incisions and a reminder to always check the depth and alignment of the sutures for the best cosmetic and functional outcome. The presenter also mentions an upcoming video discussing suture materials in more detail.
Takeaways
- 📚 The video is a tutorial on the subcuticular (sub-q) suture stitch, which is important for closing skin to achieve a neat appearance.
- 🎁 The video is sponsored by Medical Creations, who provided a suture kit that includes various tools such as a needle driver, scissors, scalpel, and hemostat.
- 🧵 The presenter uses 3-0 nylon for the demonstration, noting that while it's not typically used for subcuticular sutures, it is used here for visibility.
- 👆 Correct technique involves using the needle driver in a specific grip, with fingers close to the tip and at a certain position on the needle for control.
- 🔄 The suture should be placed in the dermis layer beneath the epidermis, not within the epidermis itself.
- 🤚 The process involves alternating between deep and superficial layers on opposite sides, ensuring the knot is tied deep and remains hidden.
- 🤝 Both ends of the suture must come out on the same side to avoid depressing the suture and affecting the skin closure.
- 🧍♂️ The presenter emphasizes the importance of pulling the skin together correctly and adjusting the suture if the closure isn't as desired.
- 🤏 The dermis layer is crucial for a strong closure; even if the epidermis isn't perfectly aligned, the dermis should be brought together.
- 📐 The presenter demonstrates both simple interrupted and running sutures, noting that the technique may vary depending on the incision and tissue.
- 👐 Backhand suture technique is also discussed, which involves a different approach to the needle's path to create an 'S' shape in the suture.
- ✂️ At the end of the suture, the presenter explains how to avoid tangling and ensure a flush finish, especially when using polyfilament sutures.
Q & A
What is the purpose of the sub-Q (subcuticular) suture?
-The sub-Q suture is used for closing the skin in a way that results in a neat and aesthetically pleasing appearance.
Why is it important to use a suture kit for practicing suturing techniques?
-A suture kit provides all the necessary tools and materials, such as a needle driver, scissors, scalpel, and hemostat, which are essential for safely and effectively practicing suturing techniques.
What type of suture material is typically used for sub-Q sutures?
-While the video uses 3-0 nylon for visibility, typically, a sub-Q suture does not use nylon. Instead, absorbable sutures like Vicryl are commonly used to close the skin.
How does the sub-Q suture differ from other suturing techniques?
-The sub-Q suture involves passing the suture under the dermis layer, just beneath the epidermis, ensuring that the knot is hidden and the suture is on the top, pulling the skin together without causing depression.
Why is it crucial to ensure the suture ends come out on the same side?
-Having both suture ends on the same side prevents the knot from depressing the skin when tied, ensuring that the skin comes together smoothly and without any irregularities.
What is the significance of pulling lengthwise on the suture when tying a knot?
-Pulling lengthwise along the incision line helps to bring the knot down without spreading the incision open, which is essential for a secure and neat closure.
What is the backhand technique in suturing?
-The backhand technique involves a specific hand movement where the needle is inserted and then turned to create an 'S' shape, facilitating the suture to pass under the skin in a smooth arc.
How does the choice of suture material affect the final appearance of the suture?
-The choice of suture material can influence how flush the knot lies beneath the skin and how well it is hidden. Polyfilament sutures like Vicryl are less likely to cause a noticeable bump under thin skin.
What is the running suture technique used for?
-The running suture technique is used for closing incisions where a continuous, uninterrupted suture line is required, such as in laparoscopic surgeries or smaller incisions like port sites.
Why might a surgeon choose to go back and forth (reverse direction) when finishing a running suture?
-Going back and forth at the end of a running suture can prevent tangling, especially with polyfilament sutures, and reduce the risk of creating a large knot that may become a foreign body issue or suture abscess.
How does the depth of the suture insertion affect the healing process?
-Inserting the suture at the same depth as the dermis layer ensures that the strong layer of the skin is brought together, which is crucial for proper healing and maintaining the integrity of the closure.
Outlines
😀 Introduction to Sub-Q Lembert Suture Tutorial
The video begins with a greeting and an introduction to the topic, which is a suture tutorial focusing on the subcuticular (sub-q) Lembert stitch. The presenter expresses gratitude to Medical Creations for sponsoring the video and providing a suture kit that includes essential tools such as a needle driver, scissors, a scalpel, and a hemostat. The video emphasizes the importance of the sub-q Lembert stitch in skin closure for aesthetic purposes. A review of the proper technique for holding the needle driver is provided, followed by a demonstration of the stitch on a starch model due to the difficulty of working with actual skin. The presenter discusses the layers of the skin, specifically the dermis, and how the stitch should be placed within this layer. The process of tying the knot and ensuring it remains hidden is also covered, along with a note on the choice of suture material and the importance of practicing the technique.
📚 Correcting Common Mistakes and Techniques for Running Sutures
The second paragraph addresses common mistakes made by students when performing sutures, such as incorrect placement of suture ends and over-tightening, which can lead to an unsightly result. The presenter demonstrates how to properly align the suture ends and tie a knot, emphasizing the use of a single knot with polyfilament suture material like Vicryl. The importance of pulling lengthwise along the incision to tighten the knot without spreading the wound is highlighted. Additionally, the presenter shares a quick technique for running sutures, which is particularly useful for smaller incisions like port sites from laparoscopic surgeries. The video also touches on the backhand technique, a method of suturing that involves a specific hand movement and direction of the needle to create an 'S' shaped stitch path. The presenter advises on the importance of entering the next suture site at the correct depth and angle, depending on the tissue and body part being sutured.
🔍 Finishing Techniques and Tips for Subcuticular Suturing
The final paragraph discusses the finishing techniques for subcuticular suturing. The presenter demonstrates how to complete the suture by going backwards, especially in long incisions, to avoid tangling and potential complications with polyfilament sutures. The risks associated with large knots, such as suture abscesses or stitch rejection, are explained. The video concludes with a demonstration of how to secure the final knot, cut the suture, and ensure it dives back under the skin for a clean and flush result. The presenter thanks the viewers, encourages them to subscribe and share the video, and provides information on how to get a discount on the suture kits mentioned in the video.
Mindmap
Keywords
💡Sub-Q LER Stitch
💡Dermis
💡Suture Kit
💡Needle Driver
💡Scalpel
💡Hemostat
💡Nylon Suture
💡Interrupted Suture
💡Running Suture
💡Back Hand
💡Knot Tying
Highlights
The video is a suture tutorial focusing on the sub-q (subcuticular) suture stitch.
The sub-q suture stitch is important for closing skin in a cosmetically appealing manner.
Medical Creations sponsored the video and provided a suture kit for demonstration.
The suture kit includes nylon suture, a needle driver, scissors, a scalpel, and a hemostat.
The presenter uses 3-0 nylon suture for visibility, though it's not typically used for subcuticular sutures.
Proper technique involves holding the needle driver close to the tip and at an angle.
The subcuticular suture goes into the dermis, the white layer beneath the epidermis.
The suture should pass under the dermis layer, not the epidermis layer.
The knot should be tied deep and hidden to ensure a smooth skin surface.
The suture technique involves alternating between deep and superficial layers.
Vicryl 4-0 is commonly used to close skin, although Monocryl is also an option.
When suturing, it's important to ensure the suture ends come out on the same side to avoid skin depression.
The dermis is the strong layer that should be approximated for effective wound closure.
The epidermis and fat layers are not as strong as the dermis.
The presenter demonstrates how to adjust the needle driver grip for better control.
A simple interrupted suture is used for this technique.
The video also covers a running subcuticular suture for longer incisions.
Backhand technique is demonstrated for a more secure stitch.
The presenter advises against using too many knots with polyfilament sutures to prevent complications.
The video concludes with a demonstration of how to finish the suture without tangling.
A 10% discount on the suture kits is available through a link in the video comments.
Transcripts
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