skin abrasion from tying knots

[paradoxofchoice]

Not to be a prima donna, but how can I reduce abrasion on my fingers after surgeries that require many knots with polyfilament sutures? It's painful, Avagard burns, and I'm afraid of dying for AIDS. I double glove. I notice this especially when doing slip knots deep in the pelvis with long-ass vicryl. I hold the suture in my left hand and tie right handed using my index fingers. The abrasion ends up being on the lateral side of the left index finger and the distal tip of the right index finger. I sometimes switch my hand depending on my side of table.

I filled my glove with water afterwards secretly, no water leaked out. Not that that tells you much. I'm sure it's friction. I sometimes notice the same burning feeling on my fingers when holding PDS.

Am I tying wrong? I feel like I end up with granny knots if I don't use the tip of my finger to tie down the loop or if I don't hold the other half taut.

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[surgonc2017]

You're doing it right, maybe less tension on the hand you're pulling up with. You get callouses eventually. Just wait until you experience fiberwire.


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[Winged Scapula]

Occupational hazard.

As noted above, you'll get used to it, develop thicker skin and it won't hurt as much.

 

[Crayola227]

The surgeons know all here.

I cringe for your skin waiting to be callused. They have done it and it was fine, tho.

Just my 2 cents from a different approach. Quoted and edited heavily

skin breakdown -
need skin care, ongoing & preventative, in addition to hand hygeine for health professionals

research online on the topic, talk to your PCP, dermatologist even, wound care?
there are probably ways to manage your skin better if you can't change the technique of tying

ethanol laden Purell with less moisturizing agents, those cuticles start to get angry and the skin dry.... that's when you notice they put containers of lotion by the computers to compensate in some VAs

I had some cuticle cream I kept by the computer and when it was toward the end of my shift (less in/out with patients) & I was finishing up a little "break" I would take from work was rubbing some in...

betadine for surgical hand scrubbing? well, it's gentler

take the lil bit of extra time and gentleness I did with the towel from the scrub nurse to dry....

I started paying attention to how hot the water was I used to wash my hands, dishes, using gloves when I used household cleaners at home, I started to pat my hands dry with towels rather than rub them

pay attention to temperature of water you use to scrub,
use little force (you don't have to "scrub" as you know as a surgeon, just like brushing teeth though we can sort of lose our "mindfulness" with tasks),
there's a range of recommended scrub time, aim for the minimum
use betadine or gentle stuff
@Winged Scapula said a surgeon used dishsoap kept for him at the hospital, I don't suggest you be a "primma donna" but when your back is to the wall unorthodox but easily implemented solutions you learn now can be a card up your sleeve later
consider what hand sanitizer is available at your institution,
place/carry lotion if possible,
do some hand care at the end of the day
at home try to minimize wear and tear on your hands by chemicals, water, temperature

TLDR:
the surgeons can help you tie knots
maybe the derms or wound care can teach you more about skin care, breakdown, and safety?

If your program or HR becomes aware of this - they will have to deal with it from a medicolegal standpoint, although who knows if they do.
I don't know if that becomes a good thing or bad thing. Just a likely fact.
I will not connect the dots of how you seeking medical care becomes known to your program in light of HIPAA. Programs are designed to look out for the wellbeing of its residents and act in accordance with the law on such matters.

I am not trying to freak you out when so many who came before were fine not worrying or doing any of this.
I am full of anxious truisms.
Just be mindful and sure that you are generally improving as you practice medicine.
This is not medical advice, just my thoughts on my hands feeling like ****, and health management in healthcare pros
Pound of prevention and all that

 

[rokshana]

the greatest example of hubris...quoting yourself on a topic you nothing about...

 

[npappasan]

If you're getting abrasions and calluses, then you ARE doing it wrong. Suture tying isn't about being a heavy handed hamfist. You're not strapping down a mattress to the roof of your car. Supple, man. Supple. The knot just has to go down and tie off a pedicle or bring tissue together. Suturing and knot tying goal: re-APPROXIMATE, not STRANGULATE. Try just laying the knot down to the point on the tissue where it STOPS. You don't have to keep forcing the suture further after that, which is what is causing the braided suture to saw through your skin. Also, keep in mind that you are probably sawing through the patient's tissue if you are doing this. No hamfisting.

 

[dpmd]

Hmm, I only ever have issues with monofilament suture when I am tying a million knots (like when using prolene for a large ventral hernia) and it is usually from trying to do it too fast and too hard as my hands get all super slippery from the grease of lysed fat cells. Guessing a similar thing is going on for the OP. Your hands do get a little tougher overall with time, but not true calluses like you think of on people's feet who go around barefoot all the time or anything. A more gentle touch helps though.

 

[dpmd]

Yup. Big ventral hernia repairs with a million knots and monofilament sutures. Gets me everytime.

One thing that I accidentally discovered that helps is changing gloves midway through. They grip better and so I don't end up pulling as hard (it is usually a pinky I make a paper cut like wound in because I wrap my hand around trying to gain purchase when it gets too slippery)

 

[MediCane2006]

Aw I am nursing a beginning callus on my left hand from hand tying on a bunch of breast recons (have to suture in the biologic mesh on the inframammary fold and I use interrupted 2-0 PDS). It sucks.

 

[caffeinemia]

Aw I am nursing a beginning callus on my left hand from hand tying on a bunch of breast recons (have to suture in the biologic mesh on the inframammary fold and I use interrupted 2-0 PDS). It sucks.

Really? Is the ADM bleeding or what? Unless you're doing it through a NSM incision, most IMFs are wide open and you can literally push the knot down with your finger ... even instrument tie or run a vicryl... And if you're ADM is under tension while youre sewing it in then lol...

 

[MediCane2006]

Really? Is the ADM bleeding or what? Unless you're doing it through a NSM incision, most IMFs are wide open and you can literally push the knot down with your finger ... even instrument tie or run a vicryl... And if you're ADM is under tension while youre sewing it in then lol...

Lol. I miss the days of being a resident when these cases were easy.

Both were NSM with tiny incisions and the exposure sucked. And I just don't love running the IMF sutures.... I probably will once I get a few more under my belt, but I like the security of interrupted mattress sutures right now, even as painful as they are.

 

[WinslowPringle]

This is a common thing? What is everyone doing with the suture? Never experienced this....can't decide if that must mean I'm tying delicate little air knots or I have callused ham-fists...

 

[caffeinemia]

Lol. I miss the days of being a resident when these cases were easy.

Both were NSM with tiny incisions and the exposure sucked. And I just don't love running the IMF sutures.... I probably will once I get a few more under my belt, but I like the security of interrupted mattress sutures right now, even as painful as they are.

Just retract rully hard. Those flaps gonna die anyway. Damn breast surgeons.