ER suturing techniques

ER Club Suturing Practice

Computer rendered suturing techniques. The following frames depict performing a instrument tie of a surgeon's knot. This is the first knot of a simple interrupted suture.
All graphics are original creations of Henry Feldman © 1998

Here is the wound penetrating into the dermis, but it is not deep enough to require a second deep layer of sutures

Penetrate the epidermis near the wound, with enough of a margin to support the tension required. Go across the wound perpendicular to the wound. Come out through the epidermis with an equal margin from the opposite side.

Pull the suture through leaving a small tail. Wrap the needle side of the suture twice around the the hemostat/needle driver, with the needle driver on the wound side of the suture.

Grab the small tail with the end of the needle driver, leaving the two wraps around the needle driver

Pull the tail through by crossing your hands, so that the knot lays flat like in the following picture.

The 1st half of the knot should look like this. This side of the knot should lay flat. When pulling the knot tight, you want a slight eversion of the wound, making sure not to pull too tight, which will increase the scarring.

Don't dispare if it doesn't come quickly, it takes practice.
In case you're wondering how these were made, they were modeled and rendered in MetaCreations Infini-D 4.0. They are completely computer generated from scratch, and are not a painting or drawn in a painting package, but are modeled from 3D primatives.

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