technical skills – session 1

Technical Skills – Session 1Technical Skills – Session 1

Prep date:Wednesday August 6Prep date:Wednesday August 6thth 2008 2008

Instruction/practice date: August 13Instruction/practice date: August 13thth, 2008, 2008Fontbonne Rm 3, St. Joseph HospitalFontbonne Rm 3, St. Joseph Hospital

McMaster UniversityMcMaster University

Open Basic Suturing Open Basic Suturing SkillsSkills

Important DetailsImportant Details

PGY1s, need to know where Fontbonne 3 PGY1s, need to know where Fontbonne 3 isis

Come in greensCome in greens

Practice knot tying before you come – we Practice knot tying before you come – we want to see slick, quick knotswant to see slick, quick knots

PGY2s, will be paired with PGY1s (same PGY2s, will be paired with PGY1s (same pairings as before) for help/supervision.pairings as before) for help/supervision.

Important DetailsImportant Details

PGY 2s – January presenters (you will be PGY 2s – January presenters (you will be identified and reminded soon):identified and reminded soon):

Need your topics by Sept 5Need your topics by Sept 5thth

If you don’t have a topic, let us knowIf you don’t have a topic, let us know

Goals and Objectives PGYI/IIGoals and Objectives PGYI/II

To learn:To learn:One handed and two handed tiesOne handed and two handed ties

Instrument tiesInstrument ties

Suturing techniqueSuturing technique

Basic stitchesBasic stitches SimpleSimple RunningRunning SubcuticularSubcuticular

Simple Flap constructionSimple Flap construction

Goals and Objectives PGYIGoals and Objectives PGYI

All residents:All residents: practice suturing and tying on turkey skinpractice suturing and tying on turkey skin Tasks:Tasks:

1.1. Single straight incision, wavy incisionSingle straight incision, wavy incisionSimple interrupted, running and subcuticularSimple interrupted, running and subcuticular

2.2. Circle anastomosisCircle anastomosisSimple interrupted suturesSimple interrupted sutures

3.3. Z-Plasty, V-Y advancement, LimbergZ-Plasty, V-Y advancement, LimbergSimple interruptedSimple interrupted

Ortho and Plastics residentsOrtho and Plastics residents Practice stitching tendons on Pig HocksPractice stitching tendons on Pig Hocks

advice-teaching from PGYIIsadvice-teaching from PGYIIs

Goals and ObjectivesGoals and Objectives PGYIIPGYII

To practice suturing and tyingTo practice suturing and tying

To teach and supervise PGYIsTo teach and supervise PGYIs

To try more difficult suturing tasksTo try more difficult suturing tasks

Goals and Objectives PGYIIGoals and Objectives PGYII

All residents:All residents: Practice suturing and tying on turkey skinPractice suturing and tying on turkey skin

Complex shapeComplex shape

Z-plastyZ-plasty

V-Y advancement flapV-Y advancement flap

Limberg FlapLimberg Flap

Plastics/Urology/Gen SurgPlastics/Urology/Gen Surg Vascular anastomosis if time permitsVascular anastomosis if time permits

Orthopaedics/PlasticsOrthopaedics/Plastics Tendon anastomosisTendon anastomosis

Session StationsSession Stations

Basic knot-tying stationBasic knot-tying stationPractice your one and two-handed tiesPractice your one and two-handed ties

Turkey SkinTurkey SkinSuturing on a simple surfaceSuturing on a simple surface

Can use this for the Flap sessionsCan use this for the Flap sessions

Sheep LungSheep LungModel for thick tissue (thanks to John Evans)Model for thick tissue (thanks to John Evans)

Practice deep sutures, follow the curve, don’t “hork”Practice deep sutures, follow the curve, don’t “hork”

Pig HocksPig HocksTendon suturing and thick skin suturingTendon suturing and thick skin suturing

EvaluationEvaluation

You will be evaluated by:You will be evaluated by:

How well you tie knots.How well you tie knots.Ensure that an evaluator observes you tying slick, quick Ensure that an evaluator observes you tying slick, quick

one and two-handed knotsone and two-handed knots

How well you sutureHow well you suture Technique Technique (holding the instrument, trajectory of needle, economy of (holding the instrument, trajectory of needle, economy of

movement and accuracy [placement, spacing etc])movement and accuracy [placement, spacing etc])

How much and how well you get stuff doneHow much and how well you get stuff done

PGYIIs, by your ability to supervise??PGYIIs, by your ability to supervise??

The One Handed Knot -Step 1The One Handed Knot -Step 1

The One Handed Knot -Step 2The One Handed Knot -Step 2

The One Handed Knot -Step 3The One Handed Knot -Step 3

The One Handed Knot -Step 4The One Handed Knot -Step 4

The One Handed Knot -Step 5The One Handed Knot -Step 5

The One Handed Knot -Step 6The One Handed Knot -Step 6

The One Handed Knot -Step 7The One Handed Knot -Step 7

The One Handed Knot -Step 8The One Handed Knot -Step 8

The One Handed Knot -Step 9The One Handed Knot -Step 9

The One Handed Knot -Step 10The One Handed Knot -Step 10

The Two-Handed Knot -Step 1The Two-Handed Knot -Step 1

The Two-Handed Knot -Step 2The Two-Handed Knot -Step 2

The Two-Handed Knot -Step 3The Two-Handed Knot -Step 3

The Two-Handed Knot -Step 4The Two-Handed Knot -Step 4

The Two-Handed Knot -Step 5The Two-Handed Knot -Step 5

The Two-Handed Knot -Step 6The Two-Handed Knot -Step 6

The Two-Handed Knot -Step 7The Two-Handed Knot -Step 7

The Two-Handed Knot -Step 8The Two-Handed Knot -Step 8

The Two-Handed Knot -Step 9The Two-Handed Knot -Step 9

The Two-Handed Knot -Step 10The Two-Handed Knot -Step 10

The Two-Handed Knot -Step 11The Two-Handed Knot -Step 11

The Two-Handed Knot -Step 12The Two-Handed Knot -Step 12

The Two-Handed Knot -Step 13The Two-Handed Knot -Step 13

The Two-Handed Knot -Step 14The Two-Handed Knot -Step 14

Z-PlastyZ-Plasty

Limberg FlapLimberg Flap

V-Y Advancement FlapV-Y Advancement Flap

Tendon Repair StitchTendon Repair Stitch

Resources for self-directed learningResources for self-directed learning

The webThe web Many videos already made on how to tie surgical Many videos already made on how to tie surgical

knots (one and two handed and instrument ties)knots (one and two handed and instrument ties) These slides will be available to you by email.These slides will be available to you by email.

URL:URL:

http://video.google.ca/videoplay?http://video.google.ca/videoplay?docid=8499774419188060835&q=surgical+knotdocid=8499774419188060835&q=surgical+knot+tying&ei=Vn-XSKTVEYXS-gHYru2gBg&hl=en+tying&ei=Vn-XSKTVEYXS-gHYru2gBg&hl=en