Performing a Running Subcuticular Closure: Tips and Techniques

Summary

In this article, we will discuss the technique of running subcuticular closure, including tips for performing the procedure effectively. We will also cover other surgical techniques such as interrupted closure and instrument tie, as well as the challenges of performing surgery in real-life scenarios.

Tying a Running Subcuticular Closure
Using a Dissolvable Suture for Closure
Surgical Techniques: Interrupted Closure and Instrument Tie
Challenges of Performing Surgery in Real-Life Scenarios
Conclusion

Tying a Running Subcuticular Closure

The running subcuticular closure is a technique used to close a wound by creating a series of C’s in the plane of the skin. To perform this technique, the speaker advises tying three or four single-handed throws, alternating hands. They suggest pushing the needle from behind to avoid breaking or dulling the tip. After protecting the needle and pulling it through, they recommend tying four more single-handed throws.

The speaker notes that there is not much contrast between the skin and filament colors, and offers to help. They advise evert the opposite side of the skin and enter the tissue opposite to where you came out. Using the back of the needle to push it along, anchor it at the beginning. The speaker also recommends using pickups to put the tissue where you want it to go and to take a bite.

Using a Dissolvable Suture for Closure

The speaker also discusses using a dissolvable suture for closure. They demonstrate how to tie an Aberdeen Hitch, which is a knot that is hidden and does not need to be removed. This is useful when dealing with a patient who has healed well and is ready to be discharged.

For a more severe case, the speaker recommends using a simple interrupted nylon suture. They use a 3-0 nylon filament and explain the difference between it and a 4-0. The speaker emphasizes the importance of protecting the needle and trimming the tails after tying the knot.

Surgical Techniques: Interrupted Closure and Instrument Tie

The speaker discusses various surgical techniques, including interrupted closure and instrument tie. They explain that general surgeons do not typically perform instrument ties and that it is not considered civilized. Interrupted closure involves tying individual knots to close a wound. The speaker notes that some patients are more difficult than others, and that a resident may need to redo a skin closure.

Challenges of Performing Surgery in Real-Life Scenarios

The speaker acknowledges the challenges of performing surgery in real-life scenarios, such as dealing with open body cavities and blood everywhere. They note that it can be difficult to see what you are doing and that you have to rely on your sense of touch. The speaker emphasizes the importance of taking your time and being patient.

Conclusion

In conclusion, the running subcuticular closure is a useful technique for closing wounds. It involves tying a series of C’s in the plane of the skin. Other surgical techniques such as interrupted closure and instrument tie are also useful but may not be appropriate for all situations. When performing surgery in real-life scenarios, it is important to be patient and take your time.