5mm ports suturing

[cage92]

how to suture 5 mm ports? continuous subq?interrupted?
they always looks bad

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[Dr.LeoSpaceman]

Third option is skin glue only (or in conjunction with suture).

Not surprising, but people have studied this. Personally I do a simple subcuticular, then make it look good with skin glue. Though I recognize the stitch is superfluous, it makes me feel better. It's a very evidence-based approach.

 

[DoctwoB]

how to suture 5 mm ports? continuous subq?interrupted?
they always looks bad

I do a simple subQ and am usually very happy with it. In addition to making sure you enter/exit right at skin edge and making sure both needle/tail are on same side of the stitch, I find “shimmying” the knot down with quick back and forth movements of the stitch and tail prior to locking it by pulling my hands opposite each other then tying the next throw really approximates the skin edge.

But am curious about this now, will have to try skin gluing my 5s. The problem is we do a lot more robo then pure lap; not sure about skin glue only for 8s.

 

[droliver]

A single dermal stitch and one or two cutaneous sutures with like a 5-0 or 6-0 nylon will look the best. You do need them back 4-5 days post op to remove the cutaneous suture though to avoid hatching. Gluing them alone doesn’t make a great scar and often gets glue down in between the edges. It also adds $25+ per case in supply cost.

 

[WinslowPringle]

For a 5mm port with minimal tissue trauma, a single buried 4-0 monocryl suffices. Go in at the appropriate depth really through the dermis, almost half a needle-length (usually P3) back, catch the dermis, then forward right at the dermal-epidermal junction (deep to superficial) then superficial on the other side exactly across from the first stitch at the dermal-epidermal junction, almost half a needle length in catching the tissue, then down and through the dermis (to deep). The secret, like @DoctwoB , said is in the tying and shimmying. Throw your first knot (not a surgeon knot) going along the length of the incision, creating your "V" with your long and short ends of the suture and set the short end away from you. Pull the short end away from you with the needle driver and the long end toward you with your hand, tightly. Keeping tension on the suture in your hand toward you, pull the short end back toward you tightly and then really 'shimmy', truly shifting the weight between the two back and forth; you should feel the tissue and the knot catch and see the edges approximate. This is where most people fail - not enough tension and just a willy-nilly shimmy. There should be no laxity in your suture as you pull it. Then, set your 'V' the opposite way and tie to completion. Cut on the knot. No glue required.

If it is an 8, 10,12mm port site or lots of tissue desiccation/trauma, I always do two buried sutures but not interrupted; like a buried figure of 8. Deep to superficial, superficial to deep; then deep superficial, superficial deep suturing towards myself, then tie in a similar fashion.

I am master of few things, but I always have beautiful port sites. In fact, I get a little angsty when the attending wants to close because I (probably vainly...) think I do it nicer The secret is, though, that just about anything will work adequately and usually just about everyone heals up the 5mm sites ok.

 

[TheLesPaul]

I never understood why people make such a big deal about subcuticular closures. I doing running interrupted sutures all day long on blephs, brows, and facelifts, and I never have an issue with tram-tracking. I take out sutures 7-10 days or use plain gut or chromic.

I agree with your "shimmy" or whatever you call it. Residents rarely tighten the knots tight enough on the deep sutures.

 

[dpmd]

Third option is skin glue only (or in conjunction with suture).

Not surprising, but people have studied this. Personally I do a simple subcuticular, then make it look good with skin glue. Though I recognize the stitch is superfluous, it makes me feel better. It's a very evidence-based approach.

Studied by gyn. I am not sure the suturing skill compares well to general surgery (those not adept at suturing would have poor cosmetic results compared to those who are)

 

[dpmd]

A single dermal stitch and one or two cutaneous sutures with like a 5-0 or 6-0 nylon will look the best. You do need them back 4-5 days post op to remove the cutaneous suture though to avoid hatching. Gluing them alone doesn’t make a great scar and often gets glue down in between the edges. It also adds $25+ per case in supply cost.

How much does that nylon cost?

 

[droliver]

How much does that nylon cost?

About $4-5 for Ethicon's Nylon, even less for off-brands

 

[dpmd]

About $4-5 for Ethicon's Nylon, even less for off-brands

Huh, surprising

 

[vhawk]

I usually do a U stitch

And then skin glue