Suturing lacerations is one of the fun little procedures that every PA learns in PA school. Last week we learned the basics, and it was a great time. We had been looking forward to our basic suturing workshop for months, and when it arrived, we went to town with it.
To practice the techniques we had read about, our program set us up with pig feet. They were huge! Much more like pig legs than feet, which gave us plenty of skin to lacerate and repair. Right off the bat, you notice that suturing is more difficult than it looks!
There’s plenty you take for granted when you see suturing on TV or (if you’re unlucky) in the real ER:
- There is a correct way to hold everything. Scalpels are held overhand with the index on top of the blade (not like a pen/pencil). Needle drivers are held something like scissors, but between the thumb and ring finger(as opposed to the thumb and middle like when you use regular scissors). You put as little of your digits through the holes as possible. Holding things properly, we learned, gives you more control.
Suturing needles, which are shaped like a parenthesis—–> ) <—– have a sharpened cutting edge, usually on the inside of the curve. This means that to pierce skin with them, rather than forcing or pushing them, you have to rotate your wrist, almost as if you were tightening a screw. It’s a motion that once learned, makes the process much easier.
- Tying sutures can be done a million different ways, depending on the application, the type of tissue you’re joining, and the type of suture (thread) you are using. The basic stitches feel strange at first, but soon muscle memory kicks in and you sort of do them automatically. Loop – loop – grab – pull – snug. Loop – grab – pull – snug. It’s kind of like meditating actually (or knitting,from what I hear).
- The hardest part is lining up the two sides of the wound to be sutured, which is called approximating them. If you don’t line them up right, they pucker or just turn out funny, leading to a more prominent scar.
- Sometimes you have to free the skin from the underlying tissue. This is done so that you can stitch only the part you want held together. It’s done by pulling/tearing the connective under the skin by inserting the needle driver or hemostat and opening it up, which pulls the tissue away. This is called undermining the connective tissue, and it’s less damaging to blood vessels and fascia than cutting them away with a scalpel (which you’re never supposed to do).
I sutured about 5 cuts, and in just a few hours I had a much greater appreciation for surgeons, who practically do it in their sleep.
Can you really learn to suture in a day? Hell no. But you can learn the basics. Most students then buy their own suturing kit and practice in their free time with meat or a banana.