Simple Buried Stitch Demonstration

00:05 Let's talk about the simple buried stitch.

00:07 The benefit of a buried stitch as opposed to the visible stitches, that one, you don't see it.

00:12 You don't have to worry about taking it out later.

00:14 And then two, it's going to give you more cosmetic finish.

00:17 So the purpose of this is where you may want to approximate your tissue, just like a simple interrupted, but you want to do the whole technique in a buried way.

00:26 Well, it's very simple when you think about this.

00:28 You always tie to the tail.

00:30 So if I poke through the top of the tissue and come through here, Okay, just for example, it's a simple interrupted.

00:39 Now the first thing through is my needle.

00:41 The last thing through is my tail. It's just like a caboose.

00:45 The first thing through on the locomotive is the engine.

00:47 The last thing through is a caboose. Right? So wherever I start by poking in the tissue is where my tail is going to be to tie to.

00:55 My knot will have to be on the outside.

00:58 Now, let's say I want to change that up and I want to have my knot in a buried location.

01:03 Well, as it would make sense, if I want to end up in a buried location for my knot, I have to start in a buried location for my knot.

01:09 So you don't have to go in a weird backhand or anything.

01:12 You can just do all forehand. Just start deep in a forehand.

01:17 So you're going to poke yourself, which is forehand.

01:18 Okay, and then we're going to go to the other side.

01:21 We're going to poke on through.

01:24 Now, yes, I realized that I'm doing this in a way that you're going to see the straight across the top.

01:31 This is just to teach you how to do this.

01:34 Okay, so in real life, you would not have the strand go across the top of the tissue, if you're going to bury the knot.

01:40 That would just be silly, because the body is going to start building this in, and then you're going to have no way to cut the knot out.

01:46 But that said, for visibility sake and to learn the technique, we'll do like this, and then I'll show you how to fully bury it.

01:51 Okay, so when you're in a deeper incision, like this, couple things to note.

01:56 When I pull like this, it pulls it apart.

01:59 As opposed to when I pull like this on a knot up together.

02:03 So I had long strand, a little strand.

02:05 Again, all is the same exact thing long strand and little strand over once twice and get that - once, twice, and get the little tail and switch it over.

02:16 Okay, but here's the difference when you're in a deep wound now and a very not, you're going to pull in line with the incision.

02:22 So see when I do this, I can have it buried deeper down in there.

02:26 It buries more than if I go like this it pulls it open is buries it.

02:30 So do it so that it buries it by pulling in line with the incision.

02:38 And pull. Cross it over, and pull.

02:47 Okay, now I'm going to cut both right above the knot and that will bury down into the wound.

02:56 Okay? Now I will again never choose to do this so that you see the strain on top like this, It doesn't make any sense.

03:03 But now you can see that my knot has truly been buried underneath a tissue. So it should be safe down there.

03:09 All right. Well, why would I ever do this? Well, you wouldn't actually do it like this.

03:13 You do the same exact technique.

03:15 However, you wouldn't have that poke through the skin, you would just have a go through the sidewall the skin.

03:22 Now all the way up to it. Okay, so how do we do that? Well, very simple.

03:30 Sorry, I'm above the camera here.

03:32 All right, so we're going to start from deep.

03:35 Okay, but we're just going to come up through the sidewall. Okay.

03:50 We go the opposite side.

03:56 Okay, make sure we get through the tissue.

04:00 Now the angle down.

04:02 Okay, so why would we want to do this? Again, we're crossing both sides.

04:10 We're doing it all just like a simple interrupted but just the whole thing is buried. So, once, twice, and grab that tail.

04:18 fall in line with the wound.

04:21 And now you can see that it's completely buried.

04:24 Totally out of the way.

04:28 And again, because you're doing something you're never going to see again you need to use absorbable suture.

04:38 Now, I will show you one thing.

04:40 You can just cut both tails off or by the knot or some people will take and mechanically flip that knot out of the way by going underneath it and then out the other side.

04:57 And if you watch my knot, pull it down off the site.

05:01 And you get this little tail, you can cut that tail over here.

05:07 I just flip my knot around and pull it underneath it.

05:09 So just little simple thing you can do is to make sure that the tail doesn't kind of pop up through the skin.

05:14 Okay, so that is a simple buried knot.

05:19 Very good approximation.

05:20 You can do these all the way down the line of the incision.

05:23 They'll close your wound very nicely.

05:25 They do take some time, they take a little more finesse, but just make sure you have your tail and a long strand on the same side of the wound.

05:31 Don't let them cross, ones on the left and ones on the right and you cross over top of it because then you will pull the two sidewalls apart.

05:38 This has to work by having the loop over here, and then both tails coming off this side.

05:44 Okay, if they're not, then what happens is, you'll have like say, one tail over on this side.

05:48 You have your loop, then you have one tail over here.

05:50 If you pull those two tails together, and you knot I'm above that strain that crosses is going to push down on that strand that's going across from the two sides.

05:58 And I'll show you what that looks like and how that can be a problem.

06:01 Okay, so this is what it should look like what you're seeing.

06:05 But let's say, I decide to go rogue and do something a little different.

06:10 Across who can go over this way. Okay.

06:17 And don't worry about the little fat globs because that's pretty normal.

06:21 I will see how this is on one side or the other.

06:24 That's a no, no. Because when I tie these together, I'm going to be pulling these across.

06:28 I'm going to put a knot right on top.

06:30 They have to be both on the same size.

06:32 You can loop the straight up and pull these over because that way then the wound edges on both sides or proximate directly in touch each other.

06:40 Okay, that's what you need to have.

06:42 And that's what I mean by making sure you tie the knots on the same side of the strand.

06:45 Worst case scenario, you make a mistake.

06:48 And you simply just reach through and say, "Oops, I made a mistake. No big deal." Just grab it, feel it to the other side, "Oops, that doesn't work." I don't want that.

06:56 Now it's going to tie over top of it and it's going to make a weird loop right on top of my knot just going to keep my sidewalls pulled apart.

07:02 That's not what I want.

07:03 Well, you can always just simply lift it back up with a closed instrument, and then pull it back to the right side.

07:10 And now you're in business. Okay, I can close this.

07:13 It's going to look like a million bucks.