Suture Help

[HLxDrummer]

Alright I'm on my first surgical rotation and am kind of clueless on suturing. The residents are telling me what to do but can't figure it out on my own.

1. When you are burying the knot do you always go deep to superficial then superficial to deep? And with simple interrupted you go superficial to deep then deep to superficial, right?

2. Does simple interrupted always mean through the skin?

3. If you are doing subcuticular, do you need to do a deep dermal too? This is the most confusing for me. Deep dermal (is that even what it's called?) comes up to the dermal-epidermal junction then subcuticular uses that same junction as well.

Is there any resource that helps you figure out what technique to use and what layers those techniques utilize?

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[TraumaLlamaMD]

Ideally the two sutures aren't in the same space, but deep dermal sutures that come up close to the skin do make it difficult to place subcuticulars on top. See below - the deep dermal is meant to be placed, as the name suggests, deeper in the dermis, while the subcuticular is meant to run just under the skin to further approximate the surface:

vs.

The idea of using both is to completely close down the space, not just approximate the very top layer.

You're right on the knots - just picture where you want the two ends of the suture to be in order to get the knot where you want it, and that will show you where to start.

Finally, if your residents are asking you to place sutures you've never learned how to do, I think it's okay to let them know that you've never done it before, and ask that they take a moment to show you how. Worst case scenario, they don't have time and you'll have to learn later, but I think that's better than pretending you know how and placing something that they have to take out and redo.