Suturing Kit/Tutorial

[poloboy]

I've always wanted to learn suturing. Since I've got so much time in my hands before starting medical school, I was wondering if any of you current students have heard of or used a surgical suturing kit/tutorial before. This is genuinely out of curiosity to learn this skill. Any recommendations would be greatly appreciated!

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[mcloaf]

https://www.youtube.com/user/dukesutureskills

Ethicon used to give out suture kits but I don't think that's the case anymore.

That being said, this is a zero yield skill to work on before you're an M3.

 

[Psai]

Just watch it on youtube and use any string. It's very easy to pick up once you get it but requires a lot of practice to do well.

 

[Doctor Strange]

That being said, this is a zero yield skill to work on before you're an M3.

Agreed. It takes like twenty minutes to learn the actual basic motions, but it isn't worth a damn thing if you're not using it and practicing on a daily basis.

 

[poloboy]

Just watch it on youtube and use any string. It's very easy to pick up once you get it but requires a lot of practice to do well.

I guess I also want to become handy with the tools associated with suturing. Any of you heard of the suturing kit by The Apprentice Doctor?

 

[Ismet]

I guess I also want to become handy with the tools associated with suturing. Any of you heard of the suturing kit by The Apprentice Doctor?

Don't blow $69 on a kit.

 

[Doctor Strange]

I guess I also want to become handy with the tools associated with suturing. Any of you heard of the suturing kit by The Apprentice Doctor?

No, like literally listen to the multiple med students who are telling you this is a waste of time. You don't have to be a genius to know how to hold what is essentially a giant pair of tweezers. You will have ample time and opportunity to learn and perfect your technique while on your actual surgery rotation. Not to mention OB/GYN, as well.

 

[poloboy]

No, like literally listen to the multiple med students who are telling you this is a waste of time. You don't have to be a genius to know how to hold what is essentially a giant pair of tweezers. You will have ample time and opportunity to learn and perfect your technique while on your actual surgery rotation. Not to mention OB/GYN, as well.

Thanks for your input man!

 

[poloboy]

Don't blow $69 on a kit.

Yeah, 69 bucks is kinda aggressive for just a suturing kit.

 

[Crayola227]

I disagree, my school offered optional workshops M1-2, and then again as part of MS3 orientations for the surgical and ob/gyn rotations.

Those of us that had become somewhat familiar with it MS1-2 found it easier to pick back up later. A lot of manual dexterity skills are like that, there's a steep learning curve initially, and getting back on the bike later is easier.

For the surgically bound, it would be worth reviewing, say, once or twice before MS3. I found those of us from the workshop to be better overall and we got more chances to tie knots, the surgeons trusted us to do more because we could demonstrate some proficiency out of the gate. Some surgeons will be willing/have the patience to teach you these skills right then and there in the OR, and others will NOT. For some, you will need to show you can throw the first knot correctly or you are not going to be doing any.

In fact, now that I'm thinking about it, my first year I was with an FM preceptor, and the fact I could tie knots and do instrument ties meant I even got do them on patients starting first year.

I'm not saying you should spend tons of time on this. Just, the more things you know how to do, the more you get to do, typically. More and more seems there's less time to teach on the go.

The more tools in your toolkit, the more tools in your toolkit. I knew off the bat no matter what type of doc I would be, I would always want to be able to suture a wound, and I even have the supplies at home. You know, in case of the zombie apocalypse.

 

[Crayola227]

I would add that you should just use string to practice throwing ties.

You could go to any fish and tackle store to get what are essentially needle drivers, for literally 99 cents I've seen them.

Those stores would even have what could be used as suture, although I think you can get that on ebay too for really cheap. Also needle drivers there too.

You can then use chicken breasts or pig feet (think Latino grocery store) with a gash cut in them to use your needle drivers to practice instrument ties. These are typically used in med school for this purpose.

Like I said, I think it's reasonable if you want to spend a free weekend day gathering these things and learning a few throws and just simple interrupted ties.

 

[Crayola227]

In fact, those optional groups were held by student interest groups.

if you're part of a student interest group for EM, surg, ob/gyn, hell even derm, you could do a fundraiser, or see if your school would help you fund such a workshop!

you can contact faculty, arrange to get the supplies, and hold workshops and advertise them. figure out how to hold sign-ups.

1) you practice the skills
2) not a waste of time as it lets you facetime with some teaching faculty in your specialty interest
3) not a waste of time as doing "organizing" "leading" even "treasurer/fundraising" activities in specialty interest groups/educational blah blah blah are good to have on your CV for VSAS (if you apply for aways) and for your ERAS residency app. No bull****, the above stuff was actually fodder for my interviews. Some specialties might not care, just sharing my personal experience

 

[Psai]

I guess I also want to become handy with the tools associated with suturing. Any of you heard of the suturing kit by The Apprentice Doctor?

You can get the tools for free at your local hospital. But don't worry about suturing with tools, throwing knots with one of those suture holders is way easier. What's hard is laparoscopic suturing but now they have those tools that pass the needle from side to side

 

[poloboy]

I would add that you should just use string to practice throwing ties.

You could go to any fish and tackle store to get what are essentially needle drivers, for literally 99 cents I've seen them.

Those stores would even have what could be used as suture, although I think you can get that on ebay too for really cheap. Also needle drivers there too.

You can then use chicken breasts or pig feet (think Latino grocery store) with a gash cut in them to use your needle drivers to practice instrument ties. These are typically used in med school for this purpose.

Like I said, I think it's reasonable if you want to spend a free weekend day gathering these things and learning a few throws and just simple interrupted ties.

Wow, thanks for your extensive insights and advice! As an undergrad, I was part of a fundraiser and learned to "suture" a banana using garment needle and threads. It was very silly. Now, I want to learn the real ideal, like you mentioned, using chicken breast and pig feet. Out of ignorance, can I assume that instrument and simple interrupted ties are what they do mostly to close wounds?

 

[Mad Jack]

Get a needle driver, some really unripe bananas or pig's feet, and youtube. Don't blow hour money on stupid kits. You'll forget it down the line anyway, it's a use it or lose it sort of skill.

 

[Ismet]

Wow, thanks for your extensive insights and advice! As an undergrad, I was part of a fundraiser and learned to "suture" a banana using garment needle and threads. It was very silly. Now, I want to learn the real ideal, like you mentioned, using chicken breast and pig feet. Out of ignorance, can I assume that instrument and simple interrupted ties are what they do mostly to close wounds?

The banana is a perfectly fine model. Really no model you get your hands on will be the same as actually suturing a person's skin. The point of practicing, if you are going to do it, is to get familiar with the instruments and how to tie the ties so that they're not a mess and so that you get good wound edge approximation and good healing. You'll get that education when you're taught by someone who can see what you're doing and help you through it, not by watching a CD or video with a kit you got before starting med school. I can understand the eagerness to start doing something, but really, this can wait.

Instrument tie means that you use an instrument (the needle driver/hemostat) to help you tie the suture. The alternative is using your hands which is a more advanced skill that you may or may not learn in your surgery rotations. Simple interrupted is a type of suture technique. There are a lot of other sutures that are done depending on the depth of the wound, the length, where it's located, how much tension will be on it, etc.

If you're stitching up a cut in the ED, then yes you'll likely be doing simple interrupted. Depending on what surgery service you rotate through, you'll learn different ones.

 

[Taddy Mason]

Ethicon used to give out suture kits but I don't think that's the case anymore.

They still do. We had a mandatory workshop put on by Ethicon at the beginning of third year (this past June), and everyone got kits, tools, and as many sutures as you wanted to take for practice. But yeah, OP, don't worry about it until 3rd year.

 

[mcloaf]

They still do. We had a mandatory workshop put on by Ethicon at the beginning of third year, and everyone got kits, tools, and as many sutures as you wanted to take for practice. But yeah, OP, don't worry about it until 3rd year.

Interesting. They've been on backorder on the ethicon website for as long as I can remember. Admittedly I haven't checked that often though.

 

[Mr Roboto]

Our school has free learn-to-suture clinics every couple of months. It's not worth studying this ahead of time.

Bonus advice: Do literally anything besides medicine-related stuff until school starts.

 

[poloboy]

The banana is a perfectly fine model. Really no model you get your hands on will be the same as actually suturing a person's skin. The point of practicing, if you are going to do it, is to get familiar with the instruments and how to tie the ties so that they're not a mess and so that you get good wound edge approximation and good healing. You'll get that education when you're taught by someone who can see what you're doing and help you through it, not by watching a CD or video with a kit you got before starting med school. I can understand the eagerness to start doing something, but really, this can wait.

Instrument tie means that you use an instrument (the needle driver/hemostat) to help you tie the suture. The alternative is using your hands which is a more advanced skill that you may or may not learn in your surgery rotations. Simple interrupted is a type of suture technique. There are a lot of other sutures that are done depending on the depth of the wound, the length, where it's located, how much tension will be on it, etc.

If you're stitching up a cut in the ED, then yes you'll likely be doing simple interrupted. Depending on what surgery service you rotate through, you'll learn different ones.

Interesting. I didn't know you could use your hands to suture during surgeries, considering their sterile environment and all. Thank you for your response!

Our school has free learn-to-suture clinics every couple of months. It's not worth studying this ahead of time.

Bonus advice: Do literally anything besides medicine-related stuff until school starts.

I have non-medicine-related activities planned as well. Like traveling, leisure reading, and discovering new hobbies. Thanks for the advice man!

 

[Ismet]

Interesting. I didn't know you could use your hands to suture during surgeries, considering their sterile environment and all. Thank you for your response!



I have non-medicine-related activities planned as well. Like traveling, leisure reading, and discovering new hobbies. Thanks for the advice man!

You wear sterile gloves during surgery and whenever you suture somebody. The instruments are sterile, so you need to be sterile when you're touching them.

 

[mimelim]

Interesting. I didn't know you could use your hands to suture during surgeries, considering their sterile environment and all. Thank you for your response!



I have non-medicine-related activities planned as well. Like traveling, leisure reading, and discovering new hobbies. Thanks for the advice man!

At least in general and vascular surgery it is incredibly rare to tie knots with instruments. Everything is hand tied. For one, it is much much faster. Second, you can feel the tension in the suture much better. It may not make as much of a difference when using 0 suture to close the abdomen, but when I'm tying 6-0 prolene on arteries, you want to feel everything. The only time I can remember really instrument tying was in an abdominoplasty that an attending insisted on 3 layers of interrupted closures and we would have probably used 200 packs of suture if we would have hand tied everything since you can reuse instrument tied suture more.

I think that basic knot tying is worth learning the basics of before MS3 if you are surgically inclined. I certainly would not expect or want people not going into surgery to waste their time. On the other hand, being able to tie knots is one of the first steps in getting to do more. I always let the MS3 suture/tie knots when we are closing. But, I am much faster to take it away and demonstrate how to do things properly if they clearly have not practiced before. They certainly get another shot in the next case, but unless you practice on your own, you are never going to really get it.

However, by far the most important thing is, practice does NOT make perfect. PERFECT practice makes perfect. I love youtube. I use it myself even now for reviewing certain things. But, you have to know the limitations. You also have to understand that unless you are taught well, you are going to pick up bad habits that will need to be unlearned.

 

[Crayola227]

ah jeez.... allopathic forum... didn't see "accepted" medical student

this is only even worth thinking about once you start, and depending on what sort of actual clinical exposure your school gives you MS1-2.

I found myself needing instrument tie skills far more often, as I was given so many more opportunities to close skin and not much for other things. I got to hand tie some other stuff some of the time on mainly surgical rotations.

IM --> if you do anything, usually skin, instrument ties
ED --> skin wounds mostly
FM --> skin wounds, more commonly cyst/skin lesion removal closing
Peds --> same thing

Surgical rotations --> I was given more opportunities to close skin using instruments than to throw ties on deeper tissues, which isn't to say I didn't need hand throw skills

So I stand by my opinion that spending couple hours learning the basics of both isn't a bad thing MS1-2 depending. I would get familiar with the steps without getting too practiced on your own so you don't learn to do it wrong. But anyone can learn to do a decent square knot with thread from youtube.

I was also EM bound from the start, and left handed. So I benefited from a little bored fidget practice with opening and closing needle drivers at home.

I had to do extra to be sure I knew going into a workshop how to reverse all the skills that need reversing, and to master things I was expected to do right handed.

Some surgeons I worked with wouldn't tolerate any left-handed behavior while supervising me (or they couldn't seem to be able to judge my technique), so I was glad I had done a little on my own to be more ambidextrous with it. Others, once I showed I knew what I was doing right-handed would then trust me to do it left-handed.

I've been told that surgeons should be able to throw knots left or right handed no matter what handed they are.

 

[poloboy]

However, by far the most important thing is, practice does NOT make perfect. PERFECT practice makes perfect. I love youtube. I use it myself even now for reviewing certain things. But, you have to know the limitations. You also have to understand that unless you are taught well, you are going to pick up bad habits that will need to be unlearned.

I completely agree. There are tons of resources out there on YouTube and various websites. Just didn't know which ones were reliable so decided to reach out to more experienced people like yourself. I appreciate your insights!

ah jeez.... allopathic forum... didn't see "accepted" medical student

I've been told that surgeons should be able to throw knots left or right handed no matter what handed they are.

Haha, I thought people on the allopathic forum would be most knowledgeable of this topic, and it showed! I've also heard that for an aspiring surgeon, learning to do things with the left hand, as a right-handed person, is a good start.

 

[Crayola227]

I completely agree. There are tons of resources out there on YouTube and various websites. Just didn't know which ones were reliable so decided to reach out to more experienced people like yourself. I appreciate your insights!



Haha, I thought people on the allopathic forum would be most knowledgeable of this topic, and it showed! I've also heard that for an aspiring surgeon, learning to do things with the left hand, as a right-handed person, is a good start.

1) wait until you start
2) see what clinical opportunities the school is going to give you to start
3) if there's different opportunities you would like than are offered, see how to get them (shadowing different specialties, research, informal mentoring)
4) based on 2 & 3, assess whether or not those may include experiences where such skills are useful (it's good to review any common procedures for which you may be exposed to in a given clinical scenario)
5) do what we suggested to have a passing familiarity, so when your preceptor says, "come over here, what do you know about suturing/knot tying", you can say you've never done it but reviewed it on youtube and tried a few times at home with some string, ie you're worth the time to teach because you've shown some initiative, but hopefully you're still a clean slate and didn't teach yourself wrong (later when I had done supervised workshops I would bring that up, it helped me gain some trust)
6) think about skill workshops in MS1-2 for #5 and networking
7) if no skill workshops prior to MS3, think about involvement or setting up of specialty interest groups and skill workshops
8) first master things with your dominant hand before worrying about the other one. wait until you have a supervised practice session to be sure that you're doing things correctly dominant-handed before thinking about switching to the other hand

I only brought up being left-handed to say, there's some benefit to going into any first-time procedure oriented thing with some prior review, particularly if you foresee any challenges (poor memory for procedural steps, clumsiness, left-handedness, nervousness, tremor, etc)

Seriously, take a chill pill on this. You're clearly very excited and proactive to suture and throw knots, so I foresee you will do well and get opportunities. Proactive plus enthusiasm typically equals getting clinical experience.

Congrats on acceptance. Like you, I couldn't wait to roll up my sleeves.

 

[Hangry]

Walk before you can run. Odds are you end up in a different specialty anyways. Most of us do.

If you come back in 2 years after step 1 and still want to do surgery, PM me and I will help you then. A lot of the videos on youtube are crap to wade through.

 

[poloboy]

Seriously, take a chill pill on this. You're clearly very excited and proactive to suture and throw knots, so I foresee you will do well and get opportunities. Proactive plus enthusiasm typically equals getting clinical experience.

Congrats on acceptance. Like you, I couldn't wait to roll up my sleeves.

Thank you! Your posts have been genuinely helpful. I'm excited indeed. It's like I know I'll be super busy in med school, yet I have nothing productive going on now. It's a weird feeling.

If you come back in 2 years after step 1 and still want to do surgery, PM me and I will help you then. A lot of the videos on youtube are crap to wade through.

I'll hold you to it! Expect that DM in 2 years.