Figure of 8 Demonstration


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    00:05 Let's discuss the figure-of-eight stitch.

    00:07 The figure-of-eight stitch can be done multiple ways.

    00:09 In this video, I'm going to discuss with a knot that is visible.

    00:13 Now, there's multiple ways to do this so that you could have the knot that is invisible or you could have it so the x is on the top, or that the lines across that are straight across with these x's on the bottom.

    00:24 But that said, there's multiple ways to approach this.

    00:26 The first way to think about this is if you would have a incision that you want to approximate, that may need a little bit more oppositional tension, and you're worried about the tissue tearing through.

    00:38 The figure-of-eight stitch is very simple, is going to give you a little bit more tissue purchase, which is a concept that's important to understand.

    00:46 Tissue purchase refers to when tissue is held well.

    00:50 If you have poor purchase, it's not held well.

    00:53 Can tear it through easily, and you run the risk of your wound falling apart.

    00:57 So let's just go ahead and do a simple interrupted.

    01:01 Okay, my wound is being closed straight across the bottom.

    01:06 Okay, straight across.

    01:08 And if I wanted to do multiple rows of this, I will just move over and do another one.

    01:16 All right, so let's go and do another one.

    01:18 Right next to it.

    01:19 That's one.

    01:25 That's two.

    01:29 And that's basically two simple interrupteds in a row.

    01:33 What happened there? Well, it's an angle right here, right? The angle is because I had to move over to go to my next bite, that's called travel.

    01:40 When you travel down the wound, you're going to have to decide how big your bites are.

    01:44 And then that's basically what decides how many bites it will take across to actually close the wound.

    01:49 But that said, if you do one bite straight across from the bottom, that means that you have to go on an angle across the top.

    01:56 Vice versa, if you did it on the angle on the bottom, you could go straight across the top.

    02:00 The rule of figure-eights are that you always have one side, the straight across, and the opposite side has an x.

    02:05 And by the x, I mean, there's my x. Okay.

    02:12 So that's what decides my x.

    02:14 Decided what the angle of the travel is my x.

    02:18 So when I put this together, what's going to happen? Well, it's going to give me a good approximation.

    02:25 It's like four points.

    02:26 They're all pulling in together.

    02:28 Okay, so watch what happens by cinches in they all kind of pinching and pucker.

    02:33 So let's go ahead and do that.

    02:34 One, two, grab it, come back.

    02:39 Okay, it's trying to unwind on me, and be really careful.

    02:44 Now, if I pull up on my tail, I can cinch up and slide down it. Pucker real tight.

    02:53 Okay, that is called a sliding knot.

    02:56 We'll talk about that some more.

    02:57 But if your wound is kind of coming apart, that's a way for you to kind of slide down the little strand and push that knot down, and it will secure it very well.

    03:07 Okay. Three, four, five.

    03:15 Sure, why not? Okay.

    03:23 So what does that doing? Well, it made a big old bunch.

    03:26 And that's pretty disgusting looking, right? We want that on my skin.

    03:28 That it make that tighter than it probably needed to be? Well depends on what I'm trying to accomplish.

    03:33 If I'm trying to just get a bunch of tissue and hold it together, and depending on the application that may be appropriate.

    03:39 That said, if it's for deeper tissue, or tissue that's vital, that would be very inappropriate, because I would be running the risk of devitalized tissue from crushing it to hard.

    03:48 So why would I ever want to do that? Well, imagine a scenario when you're by yourself in a failing practice setting, and you don't have any help.

    03:55 And you have a patient who comes into you, and they're bleeding.

    03:58 And you have to do what you can to stop the bleeding.

    04:01 And there's other airway breathing circulation issues to worry about.

    04:04 You do an initial trauma survey, you go through, and you find some killer bleeding, you go, "Oh, I got to fix that killer bleed." Because if this patient has a bleeding artery, you may want to stop it, but you're the only person there.

    04:15 So if you can do something, just to throw a quick figure-eight on there.

    04:18 this is a hemostatic stitch. This is going to stop bleeding.

    04:20 This is a mechanical tourniquet around a blood vessel.

    04:23 So if you can cinch around an artery, so you have someone who's a laceration.

    04:27 So this is right above the radial artery, and they will laceration that gets into the radial artery.

    04:31 Well, if you can throw a figure-of-eight on it, it's basically putting a mechanical tourniquet on it.

    04:35 And now you have time to worry about other management strategies.

    04:38 So just something you can use to stop bleeding.

    04:41 This is done all the time in surgery when you have bleeders that are coming off in areas just want to kind of pinch them just kind of grabs it.

    04:47 But it is ugly and that's the problem.

    04:49 It's not cosmetic.

    04:51 But that said the opposite side of this kind of is.

    04:54 So what application could you possibly think of that we might want to do that for? Well, If you're like me, you're thinking, Well, what if I want to have one side pinch up and be really grab, you know, close a hole, maybe a round hole, maybe a biopsy hole, and then I can use the other side to pull it straight across? So what I mean by the other way, so this is the first way, we'll call this the knot on top because we poke in where the knot is, right.

    05:22 Poke in where the tail is, where you drive the train through is where the caboose eventually ends.

    05:27 We tied to the tail, which is a caboose.

    05:30 We go straight across here.

    05:31 I'm committing that my bottom is going to be straight across, which means that I'm coming in at my top is going to be on a angle.

    05:37 But what if I cross this right now? Okay, now what have I done? Well, I've committed the bottom to be on the angle.

    05:45 Then, I'm going to basically therefore be committing the top to be straight across.

    05:48 So I can just go straight across and an angle back the opposite direction.

    06:06 So this means that on the very bottom of my wound, I have my x and I have on the top of it straight lines going across.

    06:16 Okay. Now that is a far more cosmetic look to it.

    06:21 Again, keep the tail taut, and then slide down the other strands.

    06:27 And that will help you tighten it up because you want this one nice and tight at the bottom.

    06:31 Otherwise it just bounces free. It's hard to keep it tight.

    06:35 Okay, so this would be a nice way.

    06:40 If you have to close something deeper, whatever's down deep in that hole, it's all puckered shut.

    06:47 And on top is pulling straight across.

    06:50 There is some tension there.

    06:52 But that said it is closing that one very aggressively.

    06:54 Its pulling in four different ways, closing that dead space.

    06:57 So a fantastic way to do this if you have a round hole that you want to close, like a punch biopsy.

    About the Lecture

    The lecture Figure of 8 Demonstration by John Russell, DNP, APRN, AGACNP-BC, FNP-BC, CCRN, CRNFA is from the course Suturing.

    Included Quiz Questions

    1. It is a hemostatic stitch.
    2. It should not be used on punch biopsy sites.
    3. It cannot be used with sliding knots.
    4. It is only used with dissolvable sutures.
    1. Make the angle internally so that the “X” is on the bottom and the straight line is visible on top.
    2. Make the angle externally so that the “X” is on the top and the straight line is on the bottom.
    3. Have the “X” on the top of the skin and pull it tight so that the edges appear cinched.
    4. Make two “X” shapes, one on the top and one on the bottom.

    Author of lecture Figure of 8 Demonstration



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