Basics Suturing

7/30/2019 Basics Suturing

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Suturing!

Prologue Course Directors

UCSF Department of Surgery

Harras Zaid and Derek Ward, MSIIs



Goals

Develop an understanding of basic surgicaltools and their appropriate use

Learn how to do a basic instrument tie, a

running suture, and an interrupted sutureUnderstand the importance of sterile fieldsand universal precautions

Understand why good suturing is importantin wound closure



Where You will use Suturing

Think of Mr. Danovich…from the time hearrived in the ER, to his trip to the OR,

suturing was used multiple times

It is a basic skill that will be of benefit in

many clinical settings, not just the OR!

This includes OB/GYN, Family Practice, andEmergency Medicine!



Basic Tools

forceps

needle drivers

scissors



How to hold each: FORCEPS



How to hold each: NEEDLE DRIVER



How to hold each: SCISSORS



How to “Load” a Needle

Load needle at a 10-15 degree

angle relative to the needle driver

Preferably use forceps to handle

the needle

Universal precautions: avoid

needlesticks, be aware of wherethe needle is at all times, and

dispose of when done

15˚

angle



Basic Suture Types

Interrupted

Running

(“baseball stitch”)

http://www.cvm.msu.edu/courses/VM545/surgery/INDEX.HTM



Pictorial Guide:

Steps in a making a basic interrupted suture…



Needle Loading

1: Remove needle from package.2: Use

forceps to

grasp theneedle.

3: Reposition… 4: …until the

desired angle is

achieved.



Begin the suturing (a)…

1: Using forceps, pick up the tissue on

one end of the wound site and pushthe needle through.

2: Continue driving the needle…

3: Until…

Begin the s t ring (b)



Begin the suturing (b)…4: …It reaches the other end of the wound.

5: Pull the needle and thread through,

leaving only a small amount at the end.



End with the “Instrument Tie” (a)

1: Using the long end of the thread,

make two loops around the needle

driver.

loop 1

loop 2

short segment of

thread on opposite

side of wound



End with the “Instrument Tie” (b)

2: Using the needle driver, reach over and grasp

the short thread end on the opposite side.

2: Pull the short thread to complete the throw. To

complete the knot wrap the long end of the thread

around the needle driver once in the OPPOSITE

direction to the previous throw and pull the short

end through as before.



Here’s a video tutorial on how to do

this same type of suture…

http://cit.ucsf.edu:8080/ramgen/v/viper_wc05.rm

You need to be on a campus computer or have VPN

access to view this RealTime video (about 3 min 45 sec). Reviewthis helpful segment a couple of times, but don’t worry

about the specific details. The important concepts will be

reinforced in lab.






Sterile Fields and Sharps

Don’t touch bluedrapes and towels

unless you’re

“sterile”

Employ universal

precaution, and bewary of stray

sharps



Wound Healing

Approximating a wound (“primary intention”)with sutures allows for more complete healing

with less scar formation than allowing a

wound to granulate in by itself without sutures

("secondary intention")



A Little on the Phases of Wound Healing

without wound closure by sutures,

more scar tissue forms!

Modified from the Ethicon ® surgical handbook



What influences wound healing?

Basics Suturing

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