Thank you Dr Zenn for the suturing videos. Please make a detailed video on subticuticular suturing and the best way to make any kind od closure look good. Thanks again
I'm a 4th year just starting surgery auditions and this video is fantastic. I feel like a lot of what I saw on clerkships finally makes sense with regards to suture material.
Thank you so much! You have taught me how to become an expert and had to close up a wound not just with different types of knots and suturing techniques. But you actually taught me the difference between the needles be in tapered Or cutter to the actual thread be in monofilament or multi filament. Then you taught me when to use absorbed and non-absorbed sutures. You are literally my teacher at home! Thank you Dr. Zenn! 🙏💜🇺🇸
Dr. Zenn is a brilliant lecturer. I wish RU-vid had more physicians like Dr. Zenn fostering interest in medicine, surgery, and health science research. You see it in the basic sciences a lot but not as much in medicine or surgery.
You made a topic which was so intimidating easy to understand and apply!! I now have the confidence to begin my suture techniques on actual patients 🤗🤗 thank you and God bless❤❤
I’ve been researching types of sutures as I raise chickens and I may need to suture one up sometime (impacted crop, injury, etc.). I am trying to be prepared for emergencies. Avian vets are few and far between. This is the best information I have found on the internet and I have been looking for a while . I would have ordered a less than ideal suture material if I had not seen your videos. I feel more confident now. Thank you very much.
Great videos! I have seen all of them many, many times through med school and my first years in the art of surgery in Norway. I am a proud owner of your 2 volume books that take an essential place on my book shelf. The basics are the foundation that all is built upon. I can recommend that you consider a video about the main instruments used in the theater and how to use them properly. Amazing how many times I have fumbled around with anatomical forceps until I figured it out. Nobody teaches these basics unless you are lucky to find a mentor. Or you are a book collector like myself and have the essentials from Pye and Bailey etc. Thank you.
1,000 Times THANK YOU !!! for these excellent videos. Took a year off and was so rusty . And your absolutely right, we use what we do because some else did or too many choices just pick one you know. !
I have been looking for a suture class, more depth and practically. You just clicked with me. This is the best presentation and it makes sense. Thank you!!! I’m subscribing to your videos now (I don’t subscribe to anything).
Seen many as RN, OR-sutured as medic, but wether Monofilament, braided, absorbable or non-absorbable, great overview. Hopefully scrub nurse is arming needle in holder properly. Outstanding explanation & salient memories. Thank you
I work ER and i never use vicril unless its to pull in deeper tissue or to close a void if there is missing tissue. I use ethilon interrupted 90+ percent of the time in case they get infected (15 years in, nothing major but you never know). Patients sometimes get upset that they have to come back to get them removed but i think it is the safest option. I use interrupted most of the time, again if they get infected it might be part of the laceration and you can get by pulling a couple, where if you have a running stitch the whole thing has to come out. I do use running often on impatient, uncooperative, usually intoxicated patients simply for expediency.
Thank You very much Dr.Zenn for such a informative and most needed presentation for doctors in training and also for practicing doctors , my deep respects to you.
Dr. Zenn, could you please make a video with examples of bad sutures, i.e. what common things to avoid? Learning by negative example would be very helpful since, for example, I believe I would better understand what a 90-degree bite and skin eversion are if I would see a non-90-degree suture and the resulting skin inversion. Also I find it difficult in assessing if a suture is sloppy/bad, since you only show your perfectly-executed state-of-the-art sutures :) Thank you very much for your videos!
Great video Dr. Zenn. High quality and very informative :) I was wondering if you can make a video about basic and advanced knot tying with different suture materials taking into account delicate structures, suture material physics etc. Some tips and tricks in general :) Wish you all the best!
Very useful. Choice of needles: Cutting vs. reverse cutting? Nylon vs. poly....nylon is elastic so one must be very aware of tension during tying. Polypropylene is not elastic so the tension applied is the tension that remains. That's a very good thing in some applications. Absorption by hydrolysis produces virtually no inflammation and that's very good. Allergic reactions to gut do occur and can be problematic. You seem not to adhere to the old and perhaps incorrect maxim that only monofilament material should be used in subcuticular repairs to reduce the likelihood of providing a refuge for bacteria.
Many thanks, Dr Zenn for your time and effort to make this informative and practical lecture on various types of sutures and their applications available. wondering in case of facial skin closure (particularly when you remove skin cancer...), if you use an absorbable suture to close the derm first prior to place nylon sutures or you only close the skin with nylon? Best wishes
Absorbable first to bring the skin together so it is kissing. The nylon suture then has no tension on it and is perfectly aligning the skin edges for the best scar. The absorbable suture will be there for 3 weeks so you can remove the nylons early on the face (4-5 days).
If the incision or wound is long or under tension, buried absorbable sutures (vicryl) to get the tension off the skin, then interrupted or running nylon (6-0) and take them out 4-5 days.
Wow!! Thank you! Just starting to train myself, lots of questions, you gave me quite a bit to chew on, TY! I assume the suture material will affect your choice knots. So much to learn.
Thank you so much. very informative video. I was looking for this info and it was delivered perfectly. a great Teacher. I hope I can one day teach what I learned like you do.
Dr Zenn I disagree with the brand of sutures you are using. if you want a better experience you should try ETHICON SUTURES. Needles have a better performance because : 1. made with a metal alloy (chrome, cobalt, nickel, molybdenum) which prevent the needle to not bend. and if it bend, it´s never going to break. Also, the reason why the tip does not wear out. 2. The needle has a squared and fluted body so it engages to the needle holder. 3. It has a silicon recovery so it goes smooth though the tissue (doesn`t damage the tissue) 4. the needle and the thread are ensamble with a laser drill. this means needle and threat are not going to separated. AND, MOST IMPORTANT THE NEEDLE AND THE THREAD HAVE THE SAME DIAMETER. Although, Its a great video! very usefull! thanks doctor!
I use both. Really whatever the hospital stocks. Once you become an expert, you will see that the suture material differences become less and less. Just marketing.
Thanks Dr. Zenn for so interesting lesson. I'm a family doctor with a surgeon's soul, so I try to do my best with my primary care patients. One problem that's been happening to me is when I remove a skin lesion at pretibial region or at scalp of bald patients and there's tension on the suture edges. Which is the best option and with the best esthetics result, considering that silk and polypropilene sutures use to be the material available at my medical consultation?. Perhaps some suture technique is also something to keep in mind in these cases, isn't it?
In those areas, keeping the wound closed is your priority, less on cosmesis. Polypropylene or nylon are best, simple sutures or mattress sutures and leave them in 10 to 14 days.
Do you add steri-strips or other sterile glue-on strips across? I was taught to use them as aid in de-tensioning as a poor man's alternative to the tensioned fascia closures.
Dr. Zenn, I am new to your videos as I am in NP school. Thank you for your high quality educational material. I am struck by one note. You seem happier now than in your previous Duke "How to Suture" videos. I have worked in the OR as a scrub and circulator RN, and know the culture. What has changed for you?
Thank you for making these videos Dr. Zenn. I'm learning to suture and there's alot of info to absorb (no pun intended). I'm NOT fond of silk braid (4-0) there's so much drape to it. (I sew fabric as well.) My respect level for those who suture surgically has gone up by 1,000%. It looks easy to do but my hands don't want to cooperate with the instruments. Again, thank you for the videos.
I had an open, non-mesh, umbilical hernia repair done. It was a small defect in the fascia, approximately 4 mm. My surgeon wound up closing me with a non-absorbable, monofilament nylon suture. In your opinion, was nylon the best choice here or would prolene have worked better? Does it even matter?
Thanks for your information on suture. I am a patient gotten my Tommy done in July. My suture knots above my bellybutton hurts and I can feel the knots. Am I to worry about this?
I like 6-0 nylon. You have to take it out but I have had too many kids over the years have their dissolving stitches or glue come apart due to manipulation by the kids or trauma.
very informative videos. i have been practicing at home. i work in a lab where we extract oocytes from xenopus laevis for research and I am practicing and learning about surgery while home during this pandemic. thank you!
Very informative video sir..👍 i have seen vicryl sutures which are used for deep layer approximation jutting out through skin after few days, any reason behind this?
Great point. When you place absorbable sutures, the sutures should be placed so the knots get "buried" deep or they will come to the surface (called "spitting"). You accomplish this by starting the suture deep to superficial and the opposite side superficial to deep. Both ends of the suture are now deep so when you tie them the knots stay deep. The other tip is never bring the absorbable suture too close to the skin surface-stay in the deep dermis. Anything close to the epidermis will come out before it is absorbed.
I close TKA and shoulder replacements. I’ve been taught different methods. Most common things I seen are stitch abscess around 4-6 weeks post with vicryl. Do you think for these high tension areas that all interrupted is better or interrupted and when about a pickup width between deeper dermal stitches running a subcutical stitch would be best. I worry about the knots with interrupted and with running subcuticular suture breaking and failure. Also time and efficiency is ultra important. Obviously knot techniques are important
If you think the wound has a high risk of dehiscence, I would use vertical mattress nylons and forego the vicryls. If too superficial, vicryl will make it to the surface before dissolving (needs 6 weeks to dissolve) so use less or try use on deeper tissues and bury your knots. If time is an issue, throw in some vertical mattress nylons along your suture lines as insurance. I too like prineo but not on mobile areas.
Thank you for the video. When the CPT book says " require layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, what clues can I look for in the surgeon's documentation to know if the superficial nonmuscle fascia has been included. I never see surgeons mention this and many medical terminology books will say that the subcutaneous tissue is also called superficial non-muscle fascia? If the documentation lists using both an absorbably and a nonabsorbable suture, is that at least usually an indication that a layered closure of one of more of the deeper layers of subcutaneous tissue AND superficial (non-muscle) fasica has been closed? Also, is there a video you can recommend on undermining? :) Thanks!
CPT coding is forever changing. In general, suturing of the skin or subcutaneous fat(don't!) is a simple closure. Once you are closing muscle fascia, scarps's fascia, or muscle itself, it is now "intermediate." Complex usually involves some manipulation of the wound to get it closed like undermining.
How long does running subcuticular stitch must be in tissues before removing? For example when it is about skin closure with prolene after scar revision on face.
I remove sutures based on my judgment of the healing. Face has less tension and I remove them early, less than a week. If I am concerned that the wound is not strong enough yet, I often place some glue then pull the suture for an additional week or two of strength but the patient does not have to return to the office for more suture removal.
Slide at 20:30 should say Surgilon or Neurolon instead of Surgidac. Watched this video as well as the suturing and knot tying one. You are an excellent teacher. Do you ever use the teaching point that sutures break because of the "jerk at the end of the knot"?
Thanks for these videos. Esstentially, I am a subscriber so that my first aid skills become sharper. To that end, I would conclude, (as a lay person), that a braided/non absorbable suture would be prime for an emergency first aid kit - because treatment is required until medical professionals can attend. (My scenario would be first aid in an environment where transport to a clinic would be delayed sufficiently as to require temporary treatment - such as backwoods, air crash, or any non populated locations while waiting for evacuation for long periods of time). Woild this be a correct conclusion?
As a scrub tech with 45 years of experience in the OR, I did quite a bit of suturing, until lawyers got into the mix and made it necessary to have letters after your name. Most of that was skin closure, with a decided shift to subcuticular closure. I was delighted when Monocryl came out, as it is a very limp monofilament that handles nicely and ties well. BTW, allergy to Vicryl suture is rare, but real.
Great video Dr. Zenn! Do you have the source for the images (e.g., the one about "types of suture material" and the one in which the sutures are organized by color)? I'm currently doing some Anki flashcards from this video to share with fellow students, are you ok with that? If so, having the original source would allow me to add said images with a higher resolution. These types of resources have been really helpful.
Cesar I no longer have the original images but you are welcome to pass the info along in any way to help others. One trip to the OR and you can photograph the charts for suture supplies.
Do you know what sutures they use for circumcision? My urologist says they are dissolvable within about a month or so but I didn't ask what kind. Are they inter changeable with surgical glue?
Cutting needle that is large. Sutures need to widely placed since superficial passes will pull through. Horizontal mattresses work well as a bunch of tissue is pulled to a bunch of tissue. Use nylon or proline and leave them in for weeks.
Keloids are more of a reaction to injury based on genetics. Hypertrophic or thick scars can be a result of too much tension on the closure (more deep sutures!) or damage to the skin during the procedure. For keloid and hypertrophic scar formers, I arrange for laser treatments after a few weeks to shut down the inflammatory response.
