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.