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What's up, you guys? Hey, it's Dr. Buck. Thanks for watching this video. And this video is how to suture from a surgeon. So this video is actually going to be a quick and dirty guide to how I suture. This is the first video in a series of videos that are gonna teach you about suturing, suture material, instruments, and all that good stuff. I'd like to thank the folks at Medical Creations for supporting my channel by sponsoring this video, as well as sending me this suture kit I'll be using today. So what you get here is a nice little kit like that. So what you get in this kit is a pair of forceps. These are AdSense, a needle driver, scalpel, hemostats, and scissors. Perfect, right? You also get a bunch of suture and one of these pads to suture on. This is actually the old style pad. This is the new pad. It's a great little kit if you want to learn and practice at home. And the company is called Medical Creations. So let's get to it. I'm going to pull out my needle driver here and my forcep and some scissors. And I've already opened a pack of actually a 40 silk suture. We're going to go over the types of sutures and the needles and all that stuff later. But this one I want to get to the fun stuff, which is suturing. Real quick, let's talk about how to put the needle on the needle driver. You want it at about a 90 degree angle. I sometimes do a little bit of an angle forward, and that's just because my arms are triangulating the spot that I want to be. It provides a 90 degree angle to the actual incision site. So I do that sometimes. Second thing is how to hold the needle driver. You want to put your thumb and your ring finger in the needle driver. Not the index here, not the index or the middle finger. The other way you can do it is the way I do it is you palm the needle driver like that, and then that gives you more kind of like degrees of freedom, because you can actually twist it like this. But when you're starting out, if you want to do those two, that's just fine. Now, this is a pickup. This is an add some pickup because it's got teeth. This is specifically for skin. So you do want to use the tooth pickup with skin. So if I'm going to try and close this incision right here, I'm going to take this needle driver, and I want to put my finger as close to the tip of the needle driver as possible. That actually makes the tip of the needle driver more steady, and thus the needle more steady. And the more things that you can rest your hands or elbows or wrists on, the more steady you're going to be. I twist my wrist like this, and I get the needle. So it's going in about 90 degrees to the skin. Once it's in the depth that I like, I twist my wrist and I see the needle come out. You can close incisions with one or two bytes. And this one, I'm going to do two bytes and notice what I'm going to do here is pull the needle out just a little bit. And then I'm going to grab the needle exactly where I want to grab it for the next bite. And that is about two thirds back and at the tip of the needle driver, two thirds of the way back on the needle. And now what I do is since I have this exactly where I want it, this is what's good about palming, is I pull it up slowly, I twist, and I'm actually ready for the next bite. There it is. And notice I am palming, which is why I can make this move. Once I put that in the second side, I can go ahead and pull this out. Now I don't have to really hold the needle with my forceps. The reason is because once you put the needle in the tissue, the tissue should stay stable unless the patient's moving all around. And second, it'll stay stable if you hold it with the forcep. So you want to hold the tissue actually with the force up and not the needle with the force up. And if you hold the tissue in place and let go of the needle, the needle should stay right in place. And so then you can pick it up again. Now I can pull it out a little bit again. I'm going to grab it right where I want the needle driver to go for the next bite. But I'm not going to actually do next bite because we're going to tie this. And so here's another tip here a lot of students, I see we have this long suture here. A lot of people like, pull this way high, right? You're going to touch your face. You're going to hit somebody else's face. If you're in a real procedure, you're going to make it unsterall. You're going to lay this suture way out somewhere else that's not sterile. So here's a little tip here. What you can do is you just put your force up right in here, and you pull this along. And you want to pull this suture down till you got a few centimeters out there and the suture is sticking straight up. That's going to help later. So then I'm going to let go of the needle with this hand. Now, the needle is not really that dangerous when it's not attached to something. If it's attached to this, you can poke somebody. So as long as the needle is like, dangling, then typically it doesn't really cause any damage. It won't poke through anything. So what I do here is I grab usually a couple palm lengths or so. And I'm also palming the force up with my left hand. This is for right handers. And all I do is just put the needle driver in between the tail and the length of the suture. And the first one, I usually do two wraps. So this is pretty typical. Notice how much length I have. A lot of students, they make a mistake, they go like this, and then they don't have anything. It's tight and it's going to get caught in these jaws. And when you open it up, it gets caught, or it gets caught in these back here. Make a big nice loop. And then when you bring it in, I kind of brought around the back. I start to make that loop. And then look how big that loop is. And then I make another loop and it's nice and big. And then I grab this tip here, which is sticking straight up for me. And then I bring this across and I pull this through. And then I lay this down. And you pull it a little bit tight. Not too tight, just approximating the tissue. You don't want to strangulate the tissue to set this suture so it doesn't come out. For my next throw, I pull it like this. Snap it like that. And even you can set it up in the air a little bit so that way it's not laying on the skin. And then what I'm going to do is I'm going to put my needle driver between the long end and the tail again. And I'm going to make this big ol loop. I don't care if if it's too big, but I don't want it too small. And then I'm going to pull it through. And this will then secure that. Now I'm going back and forth and I'm going to make a square knot. So now I'm going to go this way. I didn't pull it up in the air, right? Bang, boom, boom, back and forth. I got a little, maybe too much there. But that is essentially simple suturing. Now this is what we call a simple interrupted suture, or knot stitch, I guess. And there are lots of different types of sutures and knots and stitches. And we're going to go over those in my other videos. But I'm just going to do a couple more for you to watch. And I'll point out a few other things. So I palm it. I can get more rotation when I palm it. That's why I do that. Your attendings might not like that at the beginning. And so you might have to put your thumb and ring finger in there, but practice palming at home. And now I'm going to do just one bite across here. I'm going to turn it up. There we go. It didn't come out very much there. And I don't have to hold this tissue with this thing. But you might have to hold the tissue to keep the needle in the same spot. So if I hold the tissue with this, I pull this across. I steady this side of the tissue. This needle is not going anywhere. Then I'm going to pull it out of just a tad. So I'm going to go right about there because two thirds of the way back is where I want to grab it, right there. And then I'm going to pull it through. And this, that's what happens when you palm it sometimes. Try to be fancy and I can do this maneuver. This is a long suture. Typically you don't use suture this long, but it's good that comes in this kit because you can practice more. So the other thing that you want to do is really you don't want to touch the needle too much because the more you touch it, the more chance you have to poke yourself. So what you can do is actually grab this suture here or by your finger and raise it up. And then set the needle in a place that you think you can pick it up. In fact, you can just grasp it a little bit, not clamp it all the way down and then turn it a little bit if you want to. And so this is going to be a figure eight suture stitch. We're going to two of them right next to each other. This is used for a lot of time for ligating a blood vessel. Put the blood vessel right in the middle there. I also use this for my abdominal incisions. The port sites for like a twelve millimeter port for a laparoscope. So it's called figure eight because we're going to make an eight out of it. See, that looks like an eight. Almost more like an X. But you know what I'm talking about. Snap this there, pull it up in the air. Put the needle drive in between the two. I already did two. Right, okay. Snap it down. With silk. You don't necessarily need to do a lot of throws. Typically. Most people say three for silk and four for Vikral. I do usually four and five extra safety. I'm doing just some more just so you can watch. And you don't have to go back and forth with silk because it's a polyfilament suture, which I'm going to talk about in the other videos as well. You can if you want that's a lot. You don't need that many for reals. That is the basics of suturing. Now you know how to do it. I'm going to talk about hand tying and different types of sutures and things like that in the other videos. So go check out those videos and I'll see you in the next one. Anyway, that is how to suture from a surgeon. That's the quick and dirty. And I'll see you in the next video. Don't forget to subscribe like share comment below. Thank you guys so much for watching. I'll see you in the next one.

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