I have struggled with wrapping my head around burying the knot at the end of a closure for 2.5 years now. This video just saved me so much headache! Thank you!
Hi Olivia - burying the knot helps prevent the knot from emerging through the suture line with a subcutaneous suture in this case (the knot tends to be quite bulky and you need to leave a little "surplus" suture to help prevent it from "undoing" itself). You would also bury the knot if placing an intradermal (subcuticular) suture. An intradermal suture differs from a subcutaneous suture in that it is placed in the actual skin (dermis) rather than the subcutaneous fat layer (as shown in the video). At the end of this video you can see the wound is still gaping open. To close the wound completely at this point you could either place skin sutures or place an intradermal suture. In that case the advantage of the intradermal suture is that there are no visible stitches for the animal to pull out. However, in that case it is even more important to bury the knot to prevent it from poking up through the skin suture line. Technically a "good" intradermal suture is more difficult to place than a subcutaneous suture.
@@JohnInns thanks so much for the comprehensive reply! I have not come across buried SQ knots yet - I am familiar with intradermals + buried knots, look really tidy! Can I also ask another question - in what situations do you close the SQ? Something in the back of my mind is telling me you don't always have to or that you can close it in conjunction with another tissue layer?
@@oliviapatterson1 If you go back to Halsted's principles of surgery, you may recall those that say "eliminate dead space" and "ensure accurate tissue apposition". So in theory you should always close the subcutaneous layer to achieve these (and reduce the likelihood of swelling post operatively and increased risk of infection). However, the subcutaneous layer varies in "thickness" from practically nothing to a thick layer of fat. The decision to suture it as a separate layer rests with the surgeon - I like to think on completion of surgery I have reconstructed the tissues to the their original state. In many cases you can "get away" with not suturing the subcutaneous layer or combining its closure with another "layer" but in doing so you may compromise optimum healing conditions.
I have struggled with wrapping my head around burying the knot at the end of a closure for 2.5 years now. This video just saved me so much headache! Thank you!
Excellent video, thank you very much :)
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Vet student here - what is the purpose of burying the knot in the SQ layer? Is it to prevent irritation to the skin?
Hi Olivia - burying the knot helps prevent the knot from emerging through the suture line with a subcutaneous suture in this case (the knot tends to be quite bulky and you need to leave a little "surplus" suture to help prevent it from "undoing" itself). You would also bury the knot if placing an intradermal (subcuticular) suture. An intradermal suture differs from a subcutaneous suture in that it is placed in the actual skin (dermis) rather than the subcutaneous fat layer (as shown in the video). At the end of this video you can see the wound is still gaping open. To close the wound completely at this point you could either place skin sutures or place an intradermal suture. In that case the advantage of the intradermal suture is that there are no visible stitches for the animal to pull out. However, in that case it is even more important to bury the knot to prevent it from poking up through the skin suture line. Technically a "good" intradermal suture is more difficult to place than a subcutaneous suture.
@@JohnInns thanks so much for the comprehensive reply! I have not come across buried SQ knots yet - I am familiar with intradermals + buried knots, look really tidy! Can I also ask another question - in what situations do you close the SQ? Something in the back of my mind is telling me you don't always have to or that you can close it in conjunction with another tissue layer?
@@oliviapatterson1 If you go back to Halsted's principles of surgery, you may recall those that say "eliminate dead space" and "ensure accurate tissue apposition". So in theory you should always close the subcutaneous layer to achieve these (and reduce the likelihood of swelling post operatively and increased risk of infection). However, the subcutaneous layer varies in "thickness" from practically nothing to a thick layer of fat. The decision to suture it as a separate layer rests with the surgeon - I like to think on completion of surgery I have reconstructed the tissues to the their original state. In many cases you can "get away" with not suturing the subcutaneous layer or combining its closure with another "layer" but in doing so you may compromise optimum healing conditions.
@@JohnInns great explanation, thank you!
@@JohnInns What suture material you use for intradermal?
thank u ~doc.^^
whats the suture material used???
I've used an absorbable suture material - Monocryl I think, but any synthetic monofilament or braided absorbable suture should be OK to use.