Basic sutures – Recall Bias

We learned to suture in MS1 during a ‘clinical campus week’ and afterward I wanted to continue practicing. I spent quite a while looking for resources, figuring out what practice supplies to purchase, etc. Eventually I summarized this in a Google Doc which was distributed among the student body. This site (esfcom.org) now serves as a more permanent place to aggregate some of these student generated resources, so I am adapting my Google Doc below …

Videos

The best suture video I’ve found for basic suturing with good technique is from a plastic surgeon at Duke. The sutures are performed on cadavers, and it’s 1080p resolution. … The video includes: simple interrupted, simple buried, vertical mattress, horizontal mattress, figure-of-8, half-buried, simple running, simple running locking, and subcuticular running sutures. Bonus points: he mentions ‘granny knots’ in the video and later replies to someone in the comments and explains in more detail there,

“When you get good at this, you can throw the same half of the stitch over and over and lock it (use the other half — other direction) with the last throw of the stitch. Two consecutive same stitches is called a “granny” and it stays in place because of the tension applied to both strands. It actually “slides” into position when tying down and is the preferred technique for advanced suturers…”

The same surgeon (Dr Michael Zenn) also has a second series [created by a company that makes suture simulation tissues] that might be worth looking at for additional reference.

Honorable mention: microsuturing video with the lecturer from Acland’s Anatomy (501 throwback!)

The online video components for The Atlas of Suturing Techniques offer short clips that show how to complete an instrument tie, as well as buried sutures and other advanced techniques, which might be useful to compare with the Duke video above.

For advanced suturing (extensor tendons, nail bed stenting, arterial ligation, etc) Brian Lin MD has a number of short videos on YouTube, many of which are of him performing the techniques on actual patients (which I find more useful than on silicone or pig’s foot). Brian Lin’s site (lacerationrepair.com) is linked below in the ‘resources’ section and is a treasure trove of suturing information.

Supplies for suture practice at home

Adson forceps. These are the forceps with the single central tooth on one side and the two (complementary) lateral teeth on the other. Adson with teeth are the “proper” forceps for grabbing and stabilizing flesh as you transit it with a needle (from what I have learned so far). https://smile.amazon.com/gp/product/B008JR2J0A

Needle holder. The one linked below requires a lot less force/tension to close it to the first click, compared to the ones the school trained us with. Using the school’s needholders left-handed was killer and left a bruise on my thumb. This one doesn’t (nor do the ones used in the emergency department when I did all of my suturing during MS2). Also worth noting that the one we used at school was likely 6” or 6.5”. I felt like it was way too long and cumbersome for my needs, so I bought the shortest needle holder I could find that also looked legit(ish). (Sadly the true left-handed ones are like $150.) Also worth noting that ‘legit’ needle holders should have cross-hatched jaw surfaces in most instances, so if you are looking at a different model, try to inspect the close-up pics of the opened jaws … if the surface is smooth or only one direction cut (like pliers/vicegrips) this isn’t a needleholder but something like a hemostat / kelly clamp. Obviously anything for $15 on Amazon is only for training at home, but the closer your training approximates the tools you’ll be handed in a hospital/clinic, the better. https://smile.amazon.com/gp/product/B01LXYK5VJ

Nylon monofilament 4/0 on a reverse cutting (RC) needle … this is the default suturing needle/thread setup that you’d see used somewhere like an UrgentCare. The higher the first number, the thinner the thread (assuming there is a slash, the first number represents going further to the right of decimal point … see below for fuller explanation). A human hair is reportedly 7/0 (source: Ligatures et sutures chirurgicales, 2011, p152). Thus, a 4/0 suture thread is roughly three times thicker than a human hair. https://smile.amazon.com/gp/product/B01NARGNOG

Suture needle/thread variety pack. Includes 3/0, 4/0, 5/0 … My experience suturing during MS2 is that you’ll likely have to suture with whatever you’re told to use, so it’s helpful to have general experience with different thread sizes and types. https://smile.amazon.com/gp/product/B07849GKRF

Three layer suture pad. Comes with a needle or two as a bonus gift. I think this is the exact one we used in our intro-to-suturing session during MS1: https://smile.amazon.com/gp/product/B0797K457K

Scissors. You may also want some surgical scissors (look at the Duke video for what he is using). I already have a small pair of scissors that work as well as whatever comes in the standard suture kit we use in the emergency department I’ve done all of my suturing in, so I just continue to use those.

Microsuture supplies. If you want to microsuture, as shown in the Acland video, you’ll need a Castroviejo needle holder. I have not purchased this, and there are some other supplies he mentions that I haven’t spent time yet to track down, but the following links is at least a start: https://smile.amazon.com/gp/product/B0752ZMQ3T

(TABLE: Ligatures et sutures chirurgicales, 2011 – As you can see from the table above, 4-0 filament, which is often preferred for most extremity wounds, is approx 0.2mm in thickness. This contrasts against 6-0, which might be used for a facial wound, and is half as thick as 4-0.)

Videos

Supplies for suture practice at home

Further Reading & Resources