Week 7/ Throwing a Stitch Pt. 1

Hey Everyone!

I have finally started to prep for my experiment on testing the difference in burst pressure on tissues sutured with V-loc, Stratafix, and regular sutures. For the methodology, I will be taking segments of pig uterus of approximately 5 cm in length, closing both ends with running sutures, and inserting a catheter in the mid-section of the segment to infuse/inflate the pipe-like structure with fluid. The pressure will be measured by the arterial line, which is connected to the catheter (see previous blog post for more details on the A-line).

I am planning to do 10-15 trials each per type of suture. Next week I will begin running tests, but as for this week, I will be preparing the segments to be tested.

To go in a bit more detail, a running stitch is one of the most basic stitches in surgery. It isn’t as pristine in appearance when compared to the other sutures (in which the suture can be hidden and only the knots can be seen on both ends). In the procedures I have seen thus far, the incisions have all been closed with the intention of minimizing damage to the skin’s appearance: in other words, so that sutures are not visible when looking at the wound. This is called a subcuticular suture.

To see how a running stitch is done as compared to a subcuticular suture, click on the highlighted links!

Pig Uterus! D’:

Working with pig uterus wasn’t as gross as I had expected, but the smell is slightly strong (especially since (as of now) I am working in the clinic’s Office). Hopefully by next week, there will be a room that I can use to run my experiments without the smell affecting everyone. If anyone is curious, pig uterus reminds me a lot of pig intestine (or rather, what I would imagine intestine to look like??) Dr. Truong even agreed with me—if the packaging had not labelled it as ‘Pig Uterus’, I’m not sure I would have known the difference.

This week when I met with Dr. Truong, I was allowed to enter the physician's dining hall, which is only open to physicians and studying med students! Eating here was super intimidating, especially as I sat next to so many doctors and professionals.

Before signing off, Happy Easter everyone! Here’s a great surgical video (warning: graphic content) to celebrate the weekend. See you guys next week!

Vanessa

Week 6/ Results

Hi Everyone!

It has been an incredible week, even without stepping into the OR once while at Banner. Over the past few days, I spent several hours completing the experimental part of my project—the portion concerning tensile strength, at least. I conducted tests that compared how tensile strength varied with the following features of sutures:

1. Size. I used only what was available in the office, so to compare different sized sutures, I used 2-0, 3-0, and 5-0 Monocryl.
2. Monofilament vs. Multifilament (braided). To compare these I used 4-0 Ethilon (monofilament) and 4-0 Nurolon (braided), both nylon sutures.
3. Barbed vs. Regular. V-loc 180 (absorbable, barbed) and Coated Vicryl (regular, braided)

V-loc 180 Sutures!!!!!!!

To see a spreadsheet of my results, click here. In the beginning of next week I would also like to run some tests on the tensile strength of Stratafix sutures to compare to the results for the V-loc sutures. They are quite similar barbed sutures but provided by a different company, Ethicon. I will also begin to analyze the results gathered from the tensile strength tests. To do so, I will be finding a 95% confidence interval for each type of suture, and compare the different properties to see if there is a statistically significant difference (s/o to Mr. Peacher and our Stats class!)

Next week, I will be starting a new phase of my project. Using sutured tissue, I will be measuring the burst pressure of the tissue samples once they have been closed with either V-loc, Stratafix, or regular sutures. To summarize, burst pressure describes the maximum amount of pressure an inflated object (a pipe, usually) can withstand before the apparatus begins to leak/break/tear. To conduct this experiment, I will be using an arterial line to measure the pressure. It works, generally, like this:

The A-line will be borrowed from the ICU and the setup will be done by hospital tech, who have generously volunteered their time. Thank you so much! On another note, the tissue I will be using to test burst pressure is going to be pig uterus...Apparently this, along with the pig’s foot, can be obtained at your local asian market. Wish me luck :')

Hope that everyone has a great weekend! As colleges finally begin to release admissions decisions as well (!! D:), I hope that everyone receives good news!!!

Best,

Vanessa

Week 5/ Spring Break

This week was my ‘Spring Break’, but I still got a chance to visit the office on Friday. Dr. Truong got me a set of surgical tools (needle driver, scissors, and a pick-up) to begin practicing suturing!!

From my observations so far, suturing seems to require a lot of fine motor skills. You need to hold and wield the needle driver with precision and ease—something that can only be gained through hours of practice and hands-on experience.

Surgical scissors (bottom), needle driver/holder (middle), pick ups (top).

Today was my first day learning how to suture! I even brought a pig’s foot with me to practice on (sadly, we never got a chance to use it). So far, I’m pretty terrible. However, I did successfully learn how to tie an instrument’s tie! This tie is different from the knots I learned before in that it uses the needle driver as part of the process. It’s a lot easier than it looks and comes in handy in a procedure—in fact, most of the ties I have seen done in the OR are instrument ties.

Here’s a video that covers different types of suturing techniques, if you’re curious:

https://www.youtube.com/watch?v=TFwFMav_cpE

Anyways, despite my lack of a natural affinity for suturing, I’ve had an exciting day at Banner. Hopefully, with more practice throughout the next few weeks, I can learn the basics and be able to stitch up a cut, and even incorporate suturing into my project.

A day in spent in the office with my new suture kit :)

Holding a needle driver!!! (note: probably incorrectly)

Speaking with Dr. Truong and getting instructed on how to suture today really made me realize how amazing it is to be able to learn from a surgeon as a high school student with no medical training. I’m so grateful for the hands-on experience, and look forward to learning more in the remaining weeks.

Until next time,

Vanessa

Week 4/ Challenges

This week, I am experiencing a bit of a slump as I struggle to solidify an experiment for my project. A few challenges have come up in the last two weeks of trial testing, and I’m still working to find a way to resolve them. For example, the v-loc sutures I have been testing are difficult to secure around the hooks of the tensile strength machine. To give you guys a better idea, v-loc sutures look a bit like this up-close:

Because it is less flexible and designed to not require any knot tying (the barbs hold the suture in place), I have been struggling to wrap it around the hooks of the machine.  

These sutures are also significantly shorter than normal sutures. While typical sutures are around 45 cm (and thus, multiple trials can be run using one strand), v-loc sutures are only 15 cm in length. So, even if the v-loc suture can be successfully tied (or looped multiple times) around the hooks, there can only be one trial per strand. In the face of these problems, I may have to revise my experiment next week, and instead focus on the efficiency of each type of suture. However, I still plan to test the tensile strength of sutures. Instead of comparing v-loc and regular sutures, I might have to do a comparative analysis based on the size (1-0 vs. 3-0) and composition of suture (monofilament vs. multifilament).

Next, to cover the draining of the abscess that was mentioned in my previous posts:

An abscess is basically a collection of pus that has built up in the body. To drain it, doctors usually pack it with gauze for 1-2 days and simply wait. For larger/deeper abscesses, a draining tube is put in. In the operation I observed, Dr. Truong used a different method known as ‘Incision and Loop Drainage’. This procedure eliminates the need for packing and makes postoperative care easier.

In terms of observing surgeries, this week I watched the removal of a port. A chest port, or port-a-cath, is a device that is inserted in the body to eliminate the need to be stuck with a needle every time a patient requires IV treatment (for chemotherapy, fluid resuscitation, drawing blood, etc.) There are two parts to the device, the ‘port’ and the ‘catheter’. A catheter is a tube made of soft plastic. This is placed directly into the vein and leads to the port, a metal device that is placed under the patient’s skin. When treatment is needed, a special needle is poked to where the port is in order to access the vein. This device is especially useful for those with small or damaged veins. It was a quick, but really cool procedure! Find out more here.

That was about it for my week. See you next time!

Vanessa