Suturing questions (visual aids included!)

[Delacroix22]

Just a few questions about suturing. Just an MS3 interested in surgery and in between rotations I forget a lot of suturing terminology and just little hangups about technique.

1. When doing a buried suture for instance a "deep dermal"... where do you go "up the mountain" to do the instrument tie. On the outside of the long end/wound, or on the inside? I've never really known, and multiple youtube videos show different ways. Does it even matter?

2. When told to do a "deep dermal" suture... So you have the skin and then the "white part" directly underneath which is the dermis.... Should your bite include some of the adipose tissue immediately below? Sometimes it seems nearly impossible not to grab some of it. Also is it common to do a running subcuticular suture after doing a deep dermal? How do you go about this? Just not coming out so close to the skin when doing the deep dermal so to leave enough room to take bites and thread your subq?

Hope some of this makes sense.

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[ACSurgeon]

1- not sure I'm understanding your question. "up the mountain" is not a phrase I'm familiar with. The whole inside/outside/long end doesn't make sense to me. For a knot to be buried, you take a bite from inside to outside (or deep to superficial) on one side of the wound, and then outside to inside on the other edge. As long as both limbs of the suture are on the same side of the loop (as in your drawing), it should work out fine.

2- deep dermal sutures can be used with running subcuticular suture. You do leave yourself enough room for the superficial most layer. A deep dermal is meant to be deep dermal, but a little adipose shouldn't matter, although some surgeons might be sticklers.

 

[jperson]

In your drawing, to throw a square knot with an instrument tie the instrument that you loop the suture around should be on the 'inside'

 

[DermatoFIGHT]

The video I recommend for you is the Duke Plastic Surgery video and the Simm Suture videos. They show good technique. My suture skills were superb and I just practice every day still. Andre Agassi had to practice to get where he was 😉.

 

[spartan564]

The video I recommend for you is the Duke Plastic Surgery video and the Simm Suture videos. They show good technique. My suture skills were superb and I just practice every day still. Andre Agassi had to practice to get where he was 😉.

how do you typically practice dermatofight? do you have any recommendations for materials to practice on (i.e. pigs feet (which are not great imo) vs synthetic skin vs ?)?