Question about suturing

[DocKoozmin]

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When closing skin, do most attendings want you to do a hand tie or an instrument tie? Starting surgery rotation soon and want to know which to focus on. Most youtube videos show an instrument tie, but I've heard no one really does that in real life so I'm not sure what to believe.

 

[Smurfette]

When closing skin, do most attendings want you to do a hand tie or an instrument tie? Starting surgery rotation soon and want to know which to focus on. Most youtube videos show an instrument tie, but I've heard no one really does that in real life so I'm not sure what to believe.

Skin? Instrument tie. It conserves the most suture and lets you work on squaring your knots a bit better.

 

[Dral]

Instrument tie I would think almost always. Maybe someone wanting to just quickly hold together a trauma injury would maybe do a hand tie?

If you can find some videos of it and can pick up a spare needle driver, practice palming the instrument instead of putting your fingers through the holes every single time you need to open and close the instrument. A surgeon during one of my med school surgery rotations showed me and it's one of the really practical things I remember being taught.

 

[Spetzler-Martin]

When closing skin, do most attendings want you to do a hand tie or an instrument tie? Starting surgery rotation soon and want to know which to focus on. Most youtube videos show an instrument tie, but I've heard no one really does that in real life so I'm not sure what to believe.

This is really attending specific. I had quite a bit of OR time during my obgyn rotation. Some didn't care if you do an instrument tie while some explicitly would tell me to do hand ties.

Instrument tie I would think almost always. Maybe someone wanting to just quickly hold together a trauma injury would maybe do a hand tie?

If you can find some videos of it and can pick up a spare needle driver, practice palming the instrument instead of putting your fingers through the holes every single time you need to open and close the instrument. A surgeon during one of my med school surgery rotations showed me and it's one of the really practical things I remember being taught.

High yield. Thanks for posting this.

 

[IssaDr]

Late to the post but gonna add my two cents anyway for anyone who comes across this in the future. Like stated above, it's preceptor specific, but it's safe to just practice both. One preceptor I worked with had me purely doing instrument times. Worked with their partner for 3 days and was asked to do hand ties on day 2. This was week 4 or 5 of my rotation, and I had stopped practicing my hand ties in week 1. Surgeon mildly chewed me out stating "this is your surgery rotation, not EM or ortho." Yeah instrument ties save suture, but according to the doc and the FA, hand ties are faster (once you're good at them). This is the video I used to relearn my single hand ties