I'm a first assist student and I actually tried this today and was most proud of myself and I was teaching a resident now I can call this technique thanks!!
Hi, it's now November, 2022. I justs had my right submandibular salivary gland excised about a week ago. I'm not in the medical profession at all but I have an interest. I noticed on the hospital Discharge Summary it says "Platysma interrupted vicryl and skin - subcutaneous continuous monocryl". I had no idea what this meant. I did a google search and your very well presented and professional video popped up. It was informative without going overboard on the medical jargon. Thanks for doing this video. I always want to know what happens when I'm unconscious, after all, it is my body! The person who stitched me up did a magnificent job! Nearly as good as yours. ;)
I'm a vet tech and prospective vet student (Just waiting to hear back!) and one skill I love practicing is suturing and this video was SUPER informative! We use this suture a lot in vet med, for spays and other abdominal surgeries especially, and you by far give the best explanation and demonstration of all parts of it! And your pacing was perfect, I was able to suture along with you on my pad without having to pause or feel rushed.
Great explanation of the Halsted suture! If I may contribute: steri strips here are not added for wound strength, but rather to assure the equal height of apposed skin edges. I had to re-operate once after my assistant pulled one skin edge over the other when placing steri strips. Do not attach to one side, tension and then attach at the other side. There is no need for such pulling anyway as it is already closed, all you achieve is pulling a perfectly apposed edge over the other edge! Instead, lay down steri strips vertically, to both sides simultaneously.
Thanks for your comment and for following! I love your contribution about best steps for steri strip placement, and I agree. Perhaps that is another good idea for a new video. Again, I appreciate your comment and following!
I retired as a scrub tech after 45 years in the OR. I first used this knot to hold cargo in my pickup, then started using it in surgery. Taught it to a lot of tech students and a few residents and interns. I trained students to load needles at the 2/3-1/3 point, and a little ahead of 90 degrees, like you show. When a needle is loaded too close to the suture, there's a chance the surgeon will "horse" the needle, trying to jam it through instead of following the curve of the needle, and bend or break it.
Good tip on where to hold the needle. Thank you. I'm a Rad Tech in IR and occasionally get to suture if they let me. So I needed a refresher. Have you ever tried the suture like a surgeon kit? I just got mine. Excited!!
@@Radmxray Nope. I practiced on towels a little, then started on patients. Very early on, one of the surgeons taught me how to do a running vertical mattress suture.
If you wish to keep your sutures in the horizontal plane, then the best technique is to keep the needle holder perpendicular to the skin and use the reverse hand for the tissue opposite to yourself. This technique is also excellent for intracutaneous sutures. I learnt this from a Hungarian plastic surgeon more than 30yrs ago. Tilting the needle is but an approximation to the horizontal plane and hence not perfect.
That Aberdeen knot appears to use what’s called a marlin spike hitch in a “daisy chain.” The marlin is an awesome knot for camping and every day stuff. The daisy chain is used to store line in a way that it can be quickly deployed. There’s a way to lock this chain which is how you closed the Aberdeen. There’s a knot that uses a similar principle called the Highwayman’s knot or Bank-Robbers Knot. The uses of each of these three is obviously different but it’s pretty interesting to compare them all. This was a really cool video, I first came to this channel watching videos on sutures. It’s great learning these skills. This channel is a great resource, thanks for the video!
Roman DeBono thanks for the awesome comment! I really appreciate it. I’m glad you’ve found my channel helpful. I’m working hard to create quality, free content for students and practitioners of medicine and nursing all over the world. I’m glad to know it’s helping someone. 😊 I use this Aberdeen-style knot in a lot of things, especially when camping (like you mentioned). I’m pretty sure I first learned this knot when my grandma was trying to teach 5-year-old me how to crochet! Pretty sure it’s the main idea in basic crocheting! 😂
Well that’s good to know, I’ve never learned about crocheting but I can see how knitting needles would help create a series of connecting links. I may try to use the Aberdeen in camping but I’m pretty proficient in knots (if you couldn’t tell haha). A taut line hitch (or even a double half hitch) would seem like something that’d work. But maybe this has a particular application that it shines in beyond just suturing. I imagine this would honestly work really similarly to a clinch knot or improved clinch knot for fishing. That I will 100% need to try because I think it would really work well.
As a practicing plastic surgeon with over 40 years experience - this is an error that is frequently made by many practitioners and plastic surgical fellows. The suture technique that you demonstrate is not a subcuticular suture - it is an intracuticular suture. The suture is going into the cutis (demis) and not the subcutaneous tissue. As you properly alluded to, if there is any tension on the wound, you should place subcuticular sutures followed by the intricuticular suture.
Thank you for viewing my video and commenting. I appreciate it. I certainly understand your comment and have had conversations with my students on this exact topic. Calling the subcuticular technique subcuticular is a misnomer that originated decades ago but has continued. The word subcuticular most accurately refers to layers deep to the dermis (also commonly called subcutaneous). Intracuticular would be more accurate. However, the misnomer (which originated with plastic surgeon Carl Thiersch in 1874) has become the standard and common name for this technique. (This is discussed more here: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012124/full). Misnomers in medicine are common, interestingly. Another example is that of "scleral icterus." In this case, it is not the sclera that is jaundiced but the conjunctiva over the visible surface of the sclera. It would be more accurately stated as "conjunctival icterus." Thanks again for following and commenting, sir!
I use the term intradermal (running) suture, but frequently hear the less accurate term "intracutaneous" used by the medical students and junior surgeon's I teach on my suture technique courses. I also fairly frequently hear this term used by more experienced non-plastics surgeon's..
Few tips from an orthopaedic surgeon: After the first knot, try to flip the knot by pulling on the suture, to avoid it going loose. Please avoid pinching the skin at all costs to avoid skin trauma that could lead to bruising, swelling, leaking wounds, and infection. the best is to use the forceps as a gentle retractor than pliers. Try to handle skin with care. keep pushing skin down after each bite will not make a bad suturing better, but will add more trauma to the skin's edges. Try not to handle the needle with your fingers to avoid needlestick injury and to improve your fluency too. Try holding the needle with the needle holder immediately after finishing one bite, ready to go again for the next to improve speed and efficiency. With a good closure technique, you will need steristrips less often. otherwise, well done for the efforts to help our juniors, sir
Very well articulated and and the video is spot on as well. Thank you. Can you also share the brand of practice tissue you are using as well? It looks much more realistic than the ones I've used.
I am a surgical SHO in Ireland and this video is truly helpful I just want to ask about the material that you are using to practice it looks very good material and it doesn't break
Thanks for this. I work in IR and sometimes they allow me to close ports and permacath incisions. It's been a min, so this is very helpful. Also, is that a keratosis on your skin pad? 😆 Very realistic.
Thank you so much for your videos. I wonder if you could please reveal where you buy your stitching pad? I purchased a kit on-line, but the pad is much too stiff and unflesh-like to do a proper job of stitches such as the subcuticular. Please advise. Thank you so much!!
Thanks for the comment! This particular kit is from SurgiReal. There are a lot of options out there, some better than others. The SurgiReal kits have been my favorite so far. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
This technique is great for the face and anterior neck. I’ve also used it in the lower back closing minimally invasive discectomy incisions. It’s not good for extremities, posterior neck, shoulders, scalp, etc.
When I learned this suturing technique, I wad taught to enter the opposite side at the same level I entered first, so it doesn't look like S lines. The suture would look like this: (|) (|) (|) Instead of looking like this: (| |) (| |) Do you know what difference it makes this way? I'm still doing it like this.
I accidentally cut harm with a glass doing dishes, the doctor 👨⚕️ give me 8 stitches after 12 hours and 30 min later. He use the thin thread 🧵 polyester because they didn’t have what they normally use, the cut was deep but didn’t touch any nerve or veins, was a clean cut, he ask me to make appointment with my family doctor 👨⚕️ 10 days later, my doctor removed 3 stitches 🧵 only because started to bleed, he ask me to come back 2 days later to remove the others, it is 18 day and the cut were he removed the first 3 stitches 🧵 haven’t close completely, I can see the red inside the cut. What I should do, should I go to the hospital to have 3 stitches 🧵??? What I should do to close that cut ???
this doesnt work so good on the rubber training mats as the rubber just has too much resistance to being puilled together. Better to practice on moleskin like this video
This particular kit is from SurgiReal. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
This particular kit is from SurgiReal. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
French vet here ! We use this on "clean" surgeries (not on wound treatments or digestive surgeries for example) on dogs ans cats ! Just a pad on it to protect during the first 5 days and no big troubles until now :)
Thanks for watching! Don't forget to subscribe! www.youtube.com/@minimedlessons?sub_confirmation=1
I'm a first assist student and I actually tried this today and was most proud of myself and I was teaching a resident now I can call this technique thanks!!
Hi, it's now November, 2022. I justs had my right submandibular salivary gland excised about a week ago. I'm not in the medical profession at all but I have an interest. I noticed on the hospital Discharge Summary it says "Platysma interrupted vicryl and skin - subcutaneous continuous monocryl". I had no idea what this meant. I did a google search and your very well presented and professional video popped up. It was informative without going overboard on the medical jargon. Thanks for doing this video. I always want to know what happens when I'm unconscious, after all, it is my body! The person who stitched me up did a magnificent job! Nearly as good as yours. ;)
Glad you enjoyed my video and happy for you that it was well done with your procedure. Best wishes!
I'm a vet tech and prospective vet student (Just waiting to hear back!) and one skill I love practicing is suturing and this video was SUPER informative! We use this suture a lot in vet med, for spays and other abdominal surgeries especially, and you by far give the best explanation and demonstration of all parts of it! And your pacing was perfect, I was able to suture along with you on my pad without having to pause or feel rushed.
So glad to hear this! Best wishes with your Vet school pursuits!
I am an Operation Theatre Technologist student and I am very glad to see the video of subcuticular Continuous suture. It is extremely helpful 🙂.
I’m glad to hear that! Thanks for following along!
Such a fancy name. The normal name is just surgical technologist. “Operation theatre” technologist sounds silly
Great explanation of the Halsted suture!
If I may contribute: steri strips here are not added for wound strength, but rather to assure the equal height of apposed skin edges.
I had to re-operate once after my assistant pulled one skin edge over the other when placing steri strips.
Do not attach to one side, tension and then attach at the other side. There is no need for such pulling anyway as it is already closed, all you achieve is pulling a perfectly apposed edge over the other edge!
Instead, lay down steri strips vertically, to both sides simultaneously.
Thanks for your comment and for following! I love your contribution about best steps for steri strip placement, and I agree. Perhaps that is another good idea for a new video.
Again, I appreciate your comment and following!
I’m an intern doing my surgery rotation in India & this was very helpful, thanks 😊🙏
I'm so glad you found it helpful! Thanks for subscribing and following along!
Which college??
@@shivanisinsinwar9972 medical college😂
@@25gollalokesh20 😅
I retired as a scrub tech after 45 years in the OR. I first used this knot to hold cargo in my pickup, then started using it in surgery. Taught it to a lot of tech students and a few residents and interns. I trained students to load needles at the 2/3-1/3 point, and a little ahead of 90 degrees, like you show. When a needle is loaded too close to the suture, there's a chance the surgeon will "horse" the needle, trying to jam it through instead of following the curve of the needle, and bend or break it.
You should make a tutorial videos as well🎉
Good tip on where to hold the needle. Thank you. I'm a Rad Tech in IR and occasionally get to suture if they let me. So I needed a refresher. Have you ever tried the suture like a surgeon kit? I just got mine. Excited!!
@@Radmxray Nope. I practiced on towels a little, then started on patients. Very early on, one of the surgeons taught me how to do a running vertical mattress suture.
If you wish to keep your sutures in the horizontal plane, then the best technique is to keep the needle holder perpendicular to the skin and use the reverse hand for the tissue opposite to yourself. This technique is also excellent for intracutaneous sutures. I learnt this from a Hungarian plastic surgeon more than 30yrs ago. Tilting the needle is but an approximation to the horizontal plane and hence not perfect.
Plz record a video of that idea❤
could you explain this a bit more?
Great video!
I actually use this as a veterinarian for routine surgeries where there is no need for a recheck.
Best example of this suturing and knot out of the numerous I watched to finally understand it properly :) Thanks!
Wonderful! So glad my video was helpful! Feel free to share!
That Aberdeen knot appears to use what’s called a marlin spike hitch in a “daisy chain.” The marlin is an awesome knot for camping and every day stuff. The daisy chain is used to store line in a way that it can be quickly deployed. There’s a way to lock this chain which is how you closed the Aberdeen. There’s a knot that uses a similar principle called the Highwayman’s knot or Bank-Robbers Knot. The uses of each of these three is obviously different but it’s pretty interesting to compare them all. This was a really cool video, I first came to this channel watching videos on sutures. It’s great learning these skills. This channel is a great resource, thanks for the video!
Roman DeBono thanks for the awesome comment! I really appreciate it. I’m glad you’ve found my channel helpful. I’m working hard to create quality, free content for students and practitioners of medicine and nursing all over the world. I’m glad to know it’s helping someone. 😊 I use this Aberdeen-style knot in a lot of things, especially when camping (like you mentioned). I’m pretty sure I first learned this knot when my grandma was trying to teach 5-year-old me how to crochet! Pretty sure it’s the main idea in basic crocheting! 😂
Well that’s good to know, I’ve never learned about crocheting but I can see how knitting needles would help create a series of connecting links. I may try to use the Aberdeen in camping but I’m pretty proficient in knots (if you couldn’t tell haha). A taut line hitch (or even a double half hitch) would seem like something that’d work. But maybe this has a particular application that it shines in beyond just suturing. I imagine this would honestly work really similarly to a clinch knot or improved clinch knot for fishing. That I will 100% need to try because I think it would really work well.
finally found the perfect channel for suture
I've been searching for a good explanation about the Everdeen knot for so long! Thanks you very much ^•^
The Aberdeen knot is fantastic! I just learned something new today! 😍
burying the aberdeen knot was beautiful, thank u
This is the best suture video I’ve ever watched!!
Very informative and detailed
As a hopeful ob/gyn. Thank you for this informative video!
Very helpful... This is called the magician suturing here
The Aberdeen knot! Yes! thank you.
As a practicing plastic surgeon with over 40 years experience - this is an error that is frequently made by many practitioners and plastic surgical fellows. The suture technique that you demonstrate is not a subcuticular suture - it is an intracuticular suture. The suture is going into the cutis (demis) and not the subcutaneous tissue. As you properly alluded to, if there is any tension on the wound, you should place subcuticular sutures followed by the intricuticular suture.
Thank you for viewing my video and commenting. I appreciate it. I certainly understand your comment and have had conversations with my students on this exact topic. Calling the subcuticular technique subcuticular is a misnomer that originated decades ago but has continued. The word subcuticular most accurately refers to layers deep to the dermis (also commonly called subcutaneous). Intracuticular would be more accurate. However, the misnomer (which originated with plastic surgeon Carl Thiersch in 1874) has become the standard and common name for this technique. (This is discussed more here: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012124/full). Misnomers in medicine are common, interestingly. Another example is that of "scleral icterus." In this case, it is not the sclera that is jaundiced but the conjunctiva over the visible surface of the sclera. It would be more accurately stated as "conjunctival icterus." Thanks again for following and commenting, sir!
Why perpetuate misnomers? It is us as modern surgeons to correct the misnomers of the past.
@@elliotduboys8894 Osteoarthritis would be another great example. The term 'osteoarthrosis' is spreading, but it is quite a hard process to change.
I use the term intradermal (running) suture, but frequently hear the less accurate term "intracutaneous" used by the medical students and junior surgeon's I teach on my suture technique courses.
I also fairly frequently hear this term used by more experienced non-plastics surgeon's..
I love this style of suturing.thank you sir
Thank you. Every little detail is explained.
Thanks for following along!
Significant Video, Doc,
Hi from Ghana.
Hello to Ghana! Thanks for watching!
A very nice technique! Thanks for the demo...
Few tips from an orthopaedic surgeon:
After the first knot, try to flip the knot by pulling on the suture, to avoid it going loose.
Please avoid pinching the skin at all costs to avoid skin trauma that could lead to bruising, swelling, leaking wounds, and infection. the best is to use the forceps as a gentle retractor than pliers.
Try to handle skin with care. keep pushing skin down after each bite will not make a bad suturing better, but will add more trauma to the skin's edges.
Try not to handle the needle with your fingers to avoid needlestick injury and to improve your fluency too.
Try holding the needle with the needle holder immediately after finishing one bite, ready to go again for the next to improve speed and efficiency.
With a good closure technique, you will need steristrips less often.
otherwise, well done for the efforts to help our juniors, sir
Amazing video..
Thank you so much for such great explanation..
Very helpful. Thank you for taking your time making this video
Thanks for watching and following along!
Simply beautiful
Thank you
Very well articulated and and the video is spot on as well. Thank you. Can you also share the brand of practice tissue you are using as well? It looks much more realistic than the ones I've used.
Thank you so much for your comment and for following along! The brand of simulations skin used in this video is SurgiReal. I really like it.
Thank you very much for this video.
dele ambeke thanks for watching and commenting! I hope you’re enjoying the channel!
Great video and technique! Thank you for this and the other videos you make!
Great instructional video. Thank you!
I am a surgical SHO in Ireland and this video is truly helpful
I just want to ask about the material that you are using to practice it looks very good material and it doesn't break
Thanks! The simulation skin pad is from a company called SurgiReal.
Wonderful I'm gonna try it next time ❤
Great video! Very helpful
Thanks for this. I work in IR and sometimes they allow me to close ports and permacath incisions. It's been a min, so this is very helpful. Also, is that a keratosis on your skin pad? 😆 Very realistic.
Thank you for the knowledge
Good video. Thanks for sharing.
Beautiful.
By any chance do u have any videos using quill for skin closure? I love your videos.
Great video!
Amazing video, thanks
Thank you so much for your videos. I wonder if you could please reveal where you buy your stitching pad? I purchased a kit on-line, but the pad is much too stiff and unflesh-like to do a proper job of stitches such as the subcuticular. Please advise. Thank you so much!!
Thanks for the comment! This particular kit is from SurgiReal. There are a lot of options out there, some better than others. The SurgiReal kits have been my favorite so far. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
Awesome explaination
Great technique
Wonderful video!
Thanks sir, but can you kindly explain the difference between the intracutical suture and subcutical suture
Well explained 👏
Best suture material to use here
Very informative...Thank you!
Thank you 💕 it hepled me alot
Thank you.
In which area prefer this technique? For face? Legs? 👏👏👏
This technique is great for the face and anterior neck. I’ve also used it in the lower back closing minimally invasive discectomy incisions. It’s not good for extremities, posterior neck, shoulders, scalp, etc.
So helpful! Thanks!
satisfying closure! Thank you for sharing! :)
Thank you!
Thank you it's verry helpful
Doc,
You did not say how You also remove the sutures with this particular one after wound is heal .
use an absorbable thread, then you don't need to remove it.
You want to make sure to use absorbable suture. You leave it and it will dissolve over a few weeks. Thanks for watching!
very simple and useful
where did you get that suture pad?? mine is silicon and tears with any sub-q sutures!
When I learned this suturing technique, I wad taught to enter the opposite side at the same level I entered first, so it doesn't look like S lines.
The suture would look like this:
(|)
(|)
(|)
Instead of looking like this:
(|
|)
(|
|)
Do you know what difference it makes this way? I'm still doing it like this.
Amazing 😍😍
Is this type of suture Good for scar revision on the face?
What is the purpose of this technique? And where can we apply this technique???
I accidentally cut harm with a glass doing dishes, the doctor 👨⚕️ give me 8 stitches after 12 hours and 30 min later.
He use the thin thread 🧵 polyester because they didn’t have what they normally use, the cut was deep but didn’t touch any nerve or veins, was a clean cut, he ask me to make appointment with
my family doctor 👨⚕️ 10 days later, my doctor removed 3 stitches 🧵 only because started to bleed, he ask me to come back 2 days later to remove the others, it is 18 day and the cut were he removed the first 3 stitches 🧵 haven’t close completely, I can see the red inside the cut.
What I should do, should I go to the hospital to have 3 stitches 🧵???
What I should do to close that cut ???
What practice board is this, looks great
Thank you for helpful video
thank you. what camera did you use?
My iPhone
الله ينور يا معلمه
Can I tie instrument at the end rather than doing an Aberdeen knot?
Yes but it's said the Aberdeen is smaller.
very good.thanks
this doesnt work so good on the rubber training mats as the rubber just has too much resistance to being puilled together. Better to practice on moleskin like this video
What material is that? I've been looking for something to practice with.
This one is called a SurgiReal suturing pad.
well done
What suture pad did you used?
Thank you
Thanx a lot man ❤️
You mentioned "steristrips"!??? at the end!?
Great
What is the material you use to suture on?
good video 10/10
This reminds me the scene from Austin power, the mole
Hi) Please, tell me, what surgical training kit do you use for videos?) I want to buy one for myself)) Thanks in advance
Hello! I bought mine from SurgiReal.com
Where's the interrupted Subcuticular suture video?
This is a nice technique0
We also have this skin model，which is more realistic than this one.if you are interested in the model，you can take a look .
Thk you
Where can i get some of your realistic models?
This particular kit is from SurgiReal. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
Very nice video
Amazon
Is that a mole on the top 😃
thank u
Which suture did he use for this suture??
For this technique, we use dissolvable suture, usually something like Monocryl or fast absorbing gut.
Where do you get your suturing supplies?
This particular kit is from SurgiReal. I have no financial ties or relations with the company. Just a fan of their suture simulation supplies! surgireal.com/collections/suture-training-kits
MiniMedLessons THANK YOU SO MUCH!!!!!!
Where to buy the artificial skin to practice?
I got this from SurgiReal.
On abdomen its sometimes bit churmy
学到了，学到了
👍👍👍
I m vet doc can I use on campanion animals?
French vet here ! We use this on "clean" surgeries (not on wound treatments or digestive surgeries for example) on dogs ans cats ! Just a pad on it to protect during the first 5 days and no big troubles until now :)
If you can catch them...
why is there a mole on it lol
en...i thk the ending knot is not that necessary...