00:05
In this video, I'm going to
demonstrate the simple interrupted
stitch. We start by loading the
instrument in such a way that the
needle is about halfway down the
length of the instrument.
00:15
Okay, we're right at the tip of
the instrument.
00:17
Very close to the end here.
00:19
The teeth on the instrument will
hold just as well out here as they
do down here. And you'll have much
more control.
00:24
I have mine just a little bit over
90 degrees.
00:27
If you have it less than 90
degrees and an angle that's inward,
that's going to be detrimental to
you outward is okay, but pretty
much get close to 90.
00:35
You'll find it's much easier now.
00:37
I have a good balance of radius to
work with and leverage.
00:40
If I get really far back to the
edge here, I may find that I start
popping off the needle just
because I'm crimping it and may
come loose there. If I get out
here, then obviously I'm right by
the tip of it. It's sharp where
I'm going to be dulling it up.
00:51
At the same time, I may be
potentially causing trauma to my
suture, but I also won't have much
travel to get into the tissue.
00:58
So if I'm like, right out here, I
can't really poke it in very well.
01:01
So if you're really far back, the
opposite is true.
01:04
I can poke it really far, but I
don't have a lot more leverage.
01:06
I'm going to bend my needle, so get
kind of in the middle.
01:10
Let's go right to the middle of
our incision.
01:12
Okay. Use your tissue forceps and
your non-dominant hand to lift it
up and drive it through.
01:19
I reset it, get ready to go.
01:22
And then on the opposite side
here, I'm going to kind of think in
your mind like a pendulum. There's
a spot where you can tell this is
going to line up really nice.
01:29
Your non-dominant hand can hold
this with your tissue force
up. No matter what I do, I can use
that tissue force up as a guidance
of where to go.
01:38
I can poke right past it.
01:40
There we go. People ask how far
should I have my bites apart?
How big should they be?
Well, realize that you want to
have them enough to hold the
tissue, but typically about half
centimeter, just slightly less than
that on each side is a great way
to do this for the simple
interrupted. Okay, now that's the
first part of this movement.
01:58
Get that part down and we'll
continue on.
02:00
Feel free to pause this if you
need to at this point until you're
comfortable with the first step
moving forward.
02:07
Let's do the second step where we
actually secure this into a knot.
02:10
What we're going to do is take
this long strand that has the
needle on it, and the opposite
side has the little tail that we've
pulled through. So there's only
about an inch or so of it left.
02:19
We're going to separate the long
strand and the little tail with our
instrument, with our needle
driver. Okay.
02:24
We're going to go over once over
it twice, and then we're going to
grab the tail and then bring it
back towards us.
02:32
And doing that, you create this
nice spiral.
02:35
Okay? That spiral is that friction
you get from tooth rows as opposed
to one throw. It helps you
approximate the wound.
02:42
It's called a surgeon's throw.
02:44
Okay, cinch it up.
02:45
And then instrument's going to
separate the long strand from the
little tail. Okay.
02:49
What was far initially was my
little tail, and now it's in the
near position. They're going to
switch back and forth every time.
02:56
Okay. So long, Strand with the
needle rolls over top.
03:00
Of the instrument towards the
tail.
03:03
Grab the tail.
03:04
And then we're going to send it
away.
03:08
Okay. And then repeat.
03:12
And again, instruments going to
separate the long strand and the
tail once over top towards the
tail, grab the tail, bring it
back. Instruments can separate the
long strand from the tail.
03:25
Long strand rolls over top towards
the tail.
03:27
Same thing every time. It just
changes directions back.
03:32
And fourth. Okay.
03:34
The entire movement will be done.
03:36
A total of let's do it five times
just to practice it in real life,
you can get away with about 3 or 4
times if it's a multifilament,
which this is. If it's a
monofilament, you would not want to
do it that many times.
03:48
Okay? You would want to do more
times.
03:50
You would want to do probably six
times.
03:52
If you're doing five times with a
with the multifilament you always
want more with the monofilament
because it has memory and it wants
to unwind itself.
04:00
Okay, so that's our first movement
of the simple interrupted stitch.
04:07
Let's proceed with our simple
interrupted stitch.
04:10
I zoomed in a little bit so you
can see what we're doing here.
04:13
And this is what we should see.
04:14
We should see this back and forth
snaking like this is a square knot
that we've created. Okay?
So as you can see that we have
gone to the middle of
our wound. Now, the easiest way to
do this, we've taken a long wound
and created it into two smaller
wounds.
04:32
Now we have one here and we have
one here.
04:34
So the most common thing that I
would see done is go right to the
middle of one or the other and
then deal with them all
individually. So we're going to
create two wounds now.
04:44
We're going to have four wounds,
then we're going to have eight
wounds and then we're going to
have on we go.
04:48
So the purpose of this is to keep
dividing it equally
until we get to the place where we
have a very nicely closed and
symmetrical wound. Closure to
throws over top, grab your tail,
bring it towards you.
05:04
Okay. And send it away.
05:09
Bring it back.
05:13
Send it away.
05:20
Now you'll notice that I kept a
hold of my tail.
05:24
If you keep the tail in there,
it's a lot easier for you to come
by with your scissors and cut them
both.
05:29
One movement, save all the extra
movements again.
05:33
Extra movements equals slowing you
down.
05:35
People that are really fast at
suturing aren't doing anything
special. They're just doing fewer
extra movements.
05:41
Okay, let's go to the middle on
the right side, riding the
curve of that needle, which means
we're kind of gliding it through
the tissue. We're not bending the
needle.
05:50
We're making a smooth movement.
05:55
Okay, We get to the spot where
we're happy with it.
05:58
Trying to have it symmetrical on
both sides.
06:00
Now, if I have my tail really long
when I tie this, I'm going to have
a lot more work on my hands.
06:05
And I'm also going to be cutting a
whole bunch of extra tail off and
burning through suture.
06:09
So try to do it in such a way that
you don't waste suture.
06:12
One to grab the tail down there,
cross
over back.
06:26
Just going back and forth.
06:27
Okay.
06:35
All right. So as you can tell,
we're getting more of these done.
06:39
We'll keep on dividing and
conquering until they're all the
way done. Now, the first thing
we've noticed is there was no
tension on this wound.
06:46
It closed without any difficulty.
06:47
Right. If we make a laceration and
close it, not a big deal.
06:51
But if we have a lot of depth to
the wound, we may find that it's
much easier to deal with each
layer individually as we're closing
it and going higher and higher.
06:59
Every single layer should be
closed uniquely, otherwise you run
the risk of having areas that
aren't approximated effectively.
07:05
This wound were to pull apart.
07:07
Then we would say, Oh, we got a
problem on our hands and how do we
know that it's tight enough? Well,
if you try to pull it apart, you
can see that there's certain areas
that are still gaping and that's an
area that you would want to put
more sutures in.
07:17
But you can see the areas that
I've put sutures in have stayed
together. So you keep on putting
them in there until they're held
together. Okay, So keep on going.
07:25
Every other one and then every
other one.
07:27
And eventually you'll have a nice
even row.
07:29
You're probably about 16 or 20 of
them in there.
07:31
Okay. So give it a try and see how
it looks.