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7/30/2019 Basics Suturing
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Suturing!
Prologue Course Directors
UCSF Department of Surgery
Harras Zaid and Derek Ward, MSIIs
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Goals
Develop an understanding of basic surgicaltools and their appropriate use
Learn how to do a basic instrument tie, a
running suture, and an interrupted sutureUnderstand the importance of sterile fieldsand universal precautions
Understand why good suturing is importantin wound closure
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Where You will use Suturing
Think of Mr. Danovich…from the time hearrived in the ER, to his trip to the OR,
suturing was used multiple times
It is a basic skill that will be of benefit in
many clinical settings, not just the OR!
This includes OB/GYN, Family Practice, andEmergency Medicine!
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Basic Tools
forceps
needle drivers
scissors
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How to hold each: FORCEPS
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How to hold each: NEEDLE DRIVER
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How to hold each: SCISSORS
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How to “Load” a Needle
Load needle at a 10-15 degree
angle relative to the needle driver
Preferably use forceps to handle
the needle
Universal precautions: avoid
needlesticks, be aware of wherethe needle is at all times, and
dispose of when done
15˚
angle
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Basic Suture Types
Interrupted
Running
(“baseball stitch”)
http://www.cvm.msu.edu/courses/VM545/surgery/INDEX.HTM
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Pictorial Guide:
Steps in a making a basic interrupted suture…
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Needle Loading
1: Remove needle from package.2: Use
forceps to
grasp theneedle.
3: Reposition… 4: …until the
desired angle is
achieved.
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Begin the suturing (a)…
1: Using forceps, pick up the tissue on
one end of the wound site and pushthe needle through.
2: Continue driving the needle…
3: Until…
Begin the s t ring (b)
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Begin the suturing (b)…4: …It reaches the other end of the wound.
5: Pull the needle and thread through,
leaving only a small amount at the end.
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End with the “Instrument Tie” (a)
1: Using the long end of the thread,
make two loops around the needle
driver.
loop 1
loop 2
short segment of
thread on opposite
side of wound
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End with the “Instrument Tie” (b)
2: Using the needle driver, reach over and grasp
the short thread end on the opposite side.
2: Pull the short thread to complete the throw. To
complete the knot wrap the long end of the thread
around the needle driver once in the OPPOSITE
direction to the previous throw and pull the short
end through as before.
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Here’s a video tutorial on how to do
this same type of suture…
http://cit.ucsf.edu:8080/ramgen/v/viper_wc05.rm
You need to be on a campus computer or have VPN
access to view this RealTime video (about 3 min 45 sec). Reviewthis helpful segment a couple of times, but don’t worry
about the specific details. The important concepts will be
reinforced in lab.
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Sterile Fields and Sharps
Don’t touch bluedrapes and towels
unless you’re
“sterile”
Employ universal
precaution, and bewary of stray
sharps
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Wound Healing
Approximating a wound (“primary intention”)with sutures allows for more complete healing
with less scar formation than allowing a
wound to granulate in by itself without sutures
("secondary intention")
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A Little on the Phases of Wound Healing
without wound closure by sutures,
more scar tissue forms!
Modified from the Ethicon ® surgical handbook
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What influences wound healing?
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