00:04
A simple running technique
is probably
the fastest running technique
that there is.
00:09
It's just a simple spiral binding
of the wound, quite honestly.
00:13
But that said,
there's a couple of ways to do it.
00:15
And I'd like to show you
a couple of the techniques
that you'll find
will work pretty well.
00:18
So there are some rules when
you have a running technique
as opposed to
interrupted techniques.
00:22
One of them is you typically will
start on the dominant hand side
and work to the
nondominant hand side.
00:27
That's a typical rule.
Not all cases are like that.
00:30
But for the simple running,
that is the case for sure.
00:32
Okay, so I'm sewing right handed.
00:35
So I will encourage
that if you're right handed also,
you'll start in the
right hand side.
00:38
If you're a lefty, you started the
left hand side. Work to the right.
00:42
Okay, so start with the
simple interrupted stitch
on the right hand side
of the wound
for the righties that are going
right to left. Okay.
00:52
This is our anchor stitch.
Nothing special.
00:55
Just as simple interrupted.
just to put it together.
00:58
The difference is we're not
going to cut both tails off,
We're just going to cut off
the little tail.
01:04
And that will leave your
long strand with a needle on it
ready to be running out.
01:13
If you need to pause for a second,
feel free to pause the
screen to get to this point.
01:18
And then we'll continue on
together when you're ready.
01:24
Okay, let's proceed.
We have two decisions here.
01:27
You can have the stitches that
you see straight across like this,
or you can have them on an angle.
01:32
The difference is all made
with the next movement.
01:35
Make sure you have you're knot
up in this faraway position.
01:38
Don't have to be down at the bottom.
01:39
And you can move your knot anywhere
you want on simple interrupted.
01:42
Anywhere else that you feel,
you know, it's not a big deal.
01:45
But that's it for this one,
we're going to poke
either right next to it
or right a couple one bite away
from it. So half a centimeter.
01:53
So either we're going to poke in
and go straight underneath
to the other side.
01:55
And by doing that,
we're going to mirror this stitch.
01:59
However, by being straight
across at the bottom,
just like a figure of eight.
02:02
If one straight across, the next one
has to be on an angle on the top.
02:06
So if I want it
angled on the bottom,
that means it'll be
straight across to the top.
02:10
If I have a straight
across at the bottom,
it means it's going to be
on an angle on the top.
02:14
So it's all up to you to decide
this is the one move that matters
more than anything else
as far as deciding that.
02:19
This is the move where you
make the whole thing look
a certain way or not.
02:23
So for my purpose is,
I'm going to have it.
02:25
So I want to have it.
So the angle is on the bottom.
02:28
So I'm going to go right next to
this knot. I want to puncture in.
02:31
So you go right next to the knot
and poke through the other side.
02:35
Or you move over that distance
and you poke from here
straight underneath.
02:40
If I want the angle at the bottom,
I poke next to the knot and angle.
02:43
If I want to have a straight across
at the bottom or
angle to the top, I move over.
02:47
It's all in this
little movement here.
02:48
It's either here, or it's here
that dictates everything. Okay?
So, I have committed
to going like this.
02:59
So they're going to poke in,
and I going to angle
and I'm choosing to be
- well, I think it's a
reasonable distance for these
pulleys in line with my
incision as I go. Okay.
03:15
Yes, I'm crossing both of them.
03:16
You don't have to.
You can come up in the middle
and tighten it up as you go.
03:20
I'm tightening every
single one as I go.
03:22
To make sure I'm happy with it.
03:26
Poke in. And I'm going to curve
the needle.
03:29
Okay, try to make sure
you're symmetric
in how far away you are
from the incision.
03:34
And then pull line incision
every single time.
03:38
Okay, a certain point here,
we're going to run out of suture.
03:41
And that's okay.
Do they have to be perfect?
No, it's okay. It won't be perfect.
03:46
We may want them to be perfect.
But they won't be perfect.
03:49
Just all manner of practice.
Practice, practice, practice.
03:57
Consistency is key.
03:58
Just do everything the same
and will look the same.
04:01
You poke in. Angle over.
04:06
It's too high and more a little bit.
There you go.
04:11
As you can see, it goes pretty
quick once you get moving.
04:14
Again, angle over.
04:18
You got to choke up a little bit
to get a little more grab.
04:23
Okay. You get the idea?
I'm going to move
the camera a little bit
Got a more room to go.
04:28
And I would obviously do this
with a brand new suture.
04:32
Otherwise,
you may find yourself running out
of strand you're like, "Oh, man."
That's a bummer and it happens.
04:41
Poke in. Angle over.
04:44
And again, I'm just doing this,
this way because I so choose
to do it this way.
Chose to this way rather.
04:51
But that said you could have
done it with the angle on the top
and that's fine too.
04:54
In the event that you somehow have
a patient that cares
one way or the other
or there's someone that ask you
to do it one way or the other
then you know how to do it.
05:02
Now, I may want to pinch this
a little more.
05:04
But as I'm pulling this apart,
I don't see any airspace
so I'm doing okay.
05:07
Okay, if I crunch it more
then I'm just crunching it more,
I'm actually helping.
05:10
As long as I've managed my
tension, life is good.
05:13
And that can also pop
out, and then go back in.
05:16
You don't have to do more than one,
but like I was doing.
05:19
depends on the needle, you have to.
Okay.
05:21
When I get to the other end,
okay, what I'm going to do
is I'm going to leave
a little bit of a loop.
05:31
All right. So when I have
that little loop there,
this is how I finish it off.
05:36
I am going to leave that
loop as my little tail.
05:41
And the long strand, in this case,
not so long anymore with a needle.
05:44
And I'm going to go once, twice,
and grab the middle of that loop.
05:53
Okay. Do it again.
So you can see it.
05:55
Once. So separate the long strand
from the little tail little.
05:58
A little loop, in this case.
06:00
Once, twice. Grab the
middle of that, and pull it.
06:05
Okay, and that is how we finish it.
06:08
And then treat that
loop like the tail.
06:18
And then a certain point here,
we will be done.
06:24
Sometimes you take to kind of
put your instrument
in the middle of this little loop
and go side by side
to kind of tighten it up.
06:30
And when you're all the way done
with this, you'll cut off all three.
06:35
Okay. And that my friends is how
you do a simple running technique.
06:41
Beneficial to do this.
06:43
If you want to just close
a deeper layer really fast,
you can do the top of
the skin with this.
06:47
But realize though,
it's like a spiral bound book.
06:50
If I grab one of these and pull up,
let's say like this.
"Oh no, what's going to happen?
Well, these are really tight.
These are really tight.
06:58
These aren't really that affected.
These aren't really that affected.
07:00
But these are pinched in too tight.
And this is all loose now.
07:03
So that's not good, right?
That's a concern.
07:06
If I have an elbow
or weird external joint,
maybe this would
not be a good thing
because that tension
pulling over time
is going to effectively do this.
07:13
And they open up and
dehiscence spot on my wound.
07:16
And then I'll find that
I would have been better to do
some simple interrupted or some,
maybe some horizontal mattress
to manage the tension.
07:24
So, again, realize this is just
a gross approximation stitch.
07:28
It can go very quickly.
07:29
Great for doing for your
deep layers, the tissue
before you do your
skin layers on top.
07:33
And always if you're
doing deep layers,
realize that you're going
to use an absorbable suture,
not a nonabsorbable
suture for the skin.
07:40
Okay, so have fun.
07:42
And then again,
remember the big decision to make
is this very first one here.
07:45
If you poke in right
next to the knot
an angle on the bottom,
it'll look like this.
07:49
If you move over and then
poke in here to come out here,
well, you're going too see
the opposite of this, right?
You're going to see
the angle on the top
from this point to that point. From
this point to that point, right?
So just make the decision based
on what you want to look like
and it's all up to you.
Have some fun with it.