Suturing Banana(Edited version)

So since I’m a wannabe surgeon I have to learn to suture.Actually it’s a must for all doctors to learn how to suture.

My first experience with the sutures was way back when I was young(probably about 9 years of age).  And being an excellent cyclist then, I could cycle without both hands (not that it’s a great achievement—kids don’t learn this stunt please) it was almost always a great joy to cycle speedily and stop pedalling right before a bump.Ah bummer!!  I remembered how I heroically speed on my bike across the bump on the road and of course landed on my bum off the road. I barely got scratches and I picked myself up. I’ve decided that my adventure for the day should come to an end.

So I picked myself up and made a turn to turn into my lane. Suddenly, the nieghbour around the corner who was watering her flowers called out to me and beckoned for me in such hurry that I was kinda shocked. I stopped in front of her house and asked kindly, “Auntie, why? What happened?”

She replied, “Come girl, aiyoh, what happened? You fell down ah?”

“Oh how you know ah? You saw me right?”

“No!! Look at your shirt!!And look at your chin! Come, I walk you home now.”

I was dazed when I looked down, the front of my white tee was looking as if someone had thrown a red paintball at me. I turned and walked back towards my bike slowly. I swung my leg over the seat and sat atop of my bike, pushing my bike forward to leave when I was stopped by the lady again.

“Come girl, don’t ride anymore.Just walk with me.”

I was reluctant at first because I just wanted to reach home as soon as possible but I got down and pushed my bike instead. The walk home was a long walk. I was nervous to go home because I knew I would get a good sounding from my mother.

When I reached home, my mother thanked the lady and brought me into the bathroom to wash my wound. I laid down on my bed and closed my eyes.I wasn’t feeling the pain at all.

It’s strange, I thought to myself as I thought it would actually hurt seeing how much I bled. My mum shook me gently and told me that we should go to the Klinik Kok and let Dr Wendy have a look at it. I told my mum I felt fine and it’s not necessary but she persisted anyway.

She told me, “Kai hua liao” ( Translated from Mandarin meaning, sudah berbunga..lol my skin split like flower petals blooming") 

Dr Wendy had a look at my chin and decided it must be sutured. I was scared but I put up a brave face(you know the ego me :p) Anyway it was over in less than 5 minutes, I got 7 stitches in total.

I barely remember the details but I remembered the weird feeling of the needle pulling and tugging at my skin yet I didn’t feel the pain at all. Which is darn good ok! If not I would have cried but I didn’t.

Ok fine. A little. But not the wailings and screamings ok. Just tears rolling down.

So that concludes my experience with the 1st needle in my skin. Now let me show you how it’s like.

You’ll need this

From up to down

Scissors

Toothed forceps

Blunt forceps

Needle holder

Needle

lastly the black roll of thread and oh you need a patient

Cut your patient up if he's not already wounded

1. Sterilize everything, in my case no need since my patient is a fruit (banana)

2. Next wear gloves, in my case also no need since my patient won’t be infected with microorganisms anyway..and even if infected also neh mind. No need antibiotics also

3. Use syringe and inject 1% lidocaine ( local anaesthesia so that your patient don’t feel the pain) In my case also tak payah cuz my patient don't know how to howl in pain.

4. Stand by facing the wound like this

5. Left hand hold tooth forceps.

6.Right hand hold needle holder( left hander too bad lar..i don't know how to teach left hander)

All nice photos courtesy of NEMJ 

Start by threading the needle,use needle holder to clamp 1/3 of the needle like this

  Then use a toothed forceps to lift up part of the skin.

(oh I missed the part where you need to clean the wound with iodine..neh mind my patient very clean, cuz I cut him with sterilized knife) Right, where was I?

Oh ya lift the skin up and push needle through the skin of your patient. Make sure bite width is the same which means like this.

 

Lazy spray paint my patient.Anyway it’s the same patient,duh.

Make sure your bite width is the same. about 0.5cm-1cm depending on the size of wound and location of wound. (if thick skin then bite width more to ensure maximum tension equalling to original skin tension)

Then bla bla bla.. then surgeon knot

Ok this is a little tricky. 1st, throw aside your toothed forceps. Then pick up blunt forceps with right hand.Release your hold of the needle ( unclamp your needle holder- actually its the one looking like scissors here) and place it parallel to the wound. 

Use the blunt forceps to  clamp lower end of the thread like the above picture. This is the starting position.

Then make two round around the needle holder.End product look like this.

Without letting go the grip of both blunt forcep and needle holder, turn your left hand (your needle holder)  90 degrees and grab the upper loose end of the thread while maintaining the position of the two rounds of the thread around it.

End like this. Then remember to pull it tight (not too tight..your patient’s skin might overlap or worse tear..if overlap very ugly scar will form..if tear prepared to be sued)  till the edges pushed up slightly. So that the wound heal without a scar.

 

Just in case you are confused with my small diagram..this is bite width A and X must be of equal distance :)

Remember to repeat surgeon knot twice for each suture. Second time, place blunt forcep in same direction parallel to wound but right hand holding the needle holder need to clamp the opposite end of the thread ( meaning if you hold the lower loose end just now, now you hold the upper loose end as the starting position) 

After surgeon knot, pull both end of thread to one side of the wound and snip off the extra thread. This is one suture done. Then continue the same till you get this!

 

 

Pardon my photos, I took it with my 2mp phone camera so it’s a little fuzzy.

Remember to check bite width  and bite depth

 

Surgeon Knot No.2 (NEJM version)

Extracted from

The New England Journal of Medicine

Basic Laceration Repair

Todd W. Thomsen, M.D., Derek A. Barclay, M.D., and Gary S. Setnik, M.D.

Department of Emergency

Medicine, Mount Auburn Hospital, Cambridge,

MA (T.W.T., G.S.S.); the Department

of Emergency Medicine, Brigham and Women’s

Hospital, Boston (D.A.B.); and the

Division of Emergency Medicine, Harvard

Medical School, Boston

 

To begin the first knot, place the needle holder parallel to, and over, the wound.
Hold the needle end of the suture with your non dominant hand, allowing the needle to rest on the sterile drape.

Next, wrap the suture over the needle holder
twice. This forms the surgeon’s knot, which prevents the first “throw” from loosening.

Rotate the needle holder 90 degrees, grasp the free end of the suture, and then use your hands to pull the two ends in opposite directions across the laceration,tightening the knot only enough to approximate the wound edges.

Begin the second throw by again placing the needle holder parallel over the laceration. On this and all subsequent throws, wrap the suture over the needle holder only once
before grasping the free end with the needle holder and tightly securing the knot.

Place a total of four throws. After the final throw, pull the knot off to one side of the laceration, so that it does not lie on top of the approximated wound edges.

NOTE: It’s different ( bold words) from what I’ve learnt in class so I put it up just in case there’s contradiction with what you might have seen before or learnt before :)

THE END!

XOXO

wannabe-surgeon

Still going to practice more and more times till my left hand doesn’t shake anymore whenever I apply pressure on my forceps.