4th year student here. Wrapped up interviews and trying to stay productive. Been practice suturing, mostly horizontals/verticals and simple interrupted. Other than those which types of sutures should I be competent in or practicing before starting residency.
Suturing
- Thread starter Othello
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You just need those 3. Donati stitch is just a modified horizontal, but those can be useful for trauma or amputation flaps. You also need running subcutaneous/subcuticular pretty often... but that is basically impossible to practice with jeans or felt or most usual practice materials, so it's hard to do until you are in actual surgery or you have access to cadaver lab (maybe in residency).
Keep in mind that "advanced" suturing is simply the basics done fast, well, and reliably. Simples and running will be 90% of what you do in practice. Do simples and simples and more simples until you are ridiculously proficient with the instruments and knots (double loop with medium tension, single loop tight, single tighter... another single tightest or two if it's prolene or PDS or something slippery... or an important stitch). Practice upside down and sideways so you don't throw granny knots (pretty easy not to, just roll towards incision or knot center... but many people struggle mightily with that). When you have simples mastered and want to find a challenging and fancy stitch, then do hundreds more simples. Time yourself or race a friend if you need a way to stay interested (but still go back and quality check them and discount the ones that have bad tension or placement or spacing... "quality first, the speed will come later").
Get insanely good with the needle driver and the angle of needle insert, the spacing and the placement from the skin edges... even the cutting them at a good length for the application. If you watch very good plastics, vascular, podiatry, etc surgeons, they suture basically the same as their mediocre peers... just with slightly or much more speed, more even skin tension, less dog ears or invert/evert edges, and most importantly they do it with far fewer errors and few/no grannys. They don't waste time breaking knots since their touch is off, they don't bend needles as much from improper insert angles, they aren't usually having to re-do very many stitches since they took too big/little or deep/shallow of bites. It is a matter of millimeters and 10deg insertion errors. Just like any sport, you will be much better served if you can be amazing at the common fundamental stuff than trying to focus on the odd duck skills.
The hand ties are silly for podiatrists... there is virtually no good application in foot/ankle since you can just instrument tie any structure you might need (visible vessels, anchored tendons, etc). In podiatry, there are just no significantly deep structure you need the hand tie skill for as there tends to be in abdominal, chest, OB, etc surgery having many deep things you want to access with minimal disruption of soft surroundings. I think it is fine to learn the one basic hand tie ("two handed") but pretty stupid to spend any significant time improving it or learning alternate ones... just stay in your lane and use the instruments as you are trained. There may be one or two blue moons on your off-service where you'd actually need to use a hand tie (and even that is likely to be just because general surgeons use them often and like to use them even where ortho/pod surgeons tend to use instrument ties).
Fancy sutures like Krackow and other tendon grab ones are fine to know, but you're likely to use them so infrequently that you are better to just review them when you actually have a case on the board.
You also could try the running interlocking "baseball" stitch with jeans or whatever, but that is really only for docs working solo who would be slowed down with interrupted and don't have anyone to cut suture for them. I have never really used that baseball since it just seems like it'd be hard to take out in office later and could leave bad scars since it has a ton of friction in the line. You will be perfectly fine with simples, running, and occasional horizontals or verticals.
...good question and good idea to get faster and better. Needle drivers and sutures have been around 100+ years. Advanced stuff is nothing except the basics done properly.
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