1. Technical Skills – Session 1 Prep date:Wednesday August 6 th 2008 Instruction/practice date: August 13 th, 2008 Fontbonne Rm 3, St. Joseph Hospital McMaster University Open Basic Suturing Skills

2. Important Details PGY1s, need to know where Fontbonne 3 is Come in greens Practice knot tying before you come – we want to see slick, quick knots PGY2s, will be paired with PGY1s (same pairings as before) for help/supervision.

3. Important Details PGY 2s – January presenters (you will be identified and reminded soon): Need your topics by Sept 5 th If you don’t have a topic, let us know

4. Goals and Objectives PGYI/II To learn: One handed and two handed ties Instrument ties Suturing technique Basic stitches Simple Simple Running Running Subcuticular Subcuticular Simple Flap construction

5. Goals and Objectives PGYI All residents: practice suturing and tying on turkey skin practice suturing and tying on turkey skin Tasks: Tasks: 1.Single straight incision, wavy incision Simple interrupted, running and subcuticular 2.Circle anastomosis Simple interrupted sutures 3.Z-Plasty, V-Y advancement, Limberg Simple interrupted Ortho and Plastics residents Practice stitching tendons on Pig Hocks Practice stitching tendons on Pig Hocks advice-teaching from PGYIIs

6. Goals and ObjectivesPGYII To practice suturing and tying To teach and supervise PGYIs To try more difficult suturing tasks

7. Goals and Objectives PGYII All residents: Practice suturing and tying on turkey skin Practice suturing and tying on turkey skin Complex shape Z-plasty V-Y advancement flap Limberg Flap Plastics/Urology/Gen Surg Vascular anastomosis if time permits Vascular anastomosis if time permitsOrthopaedics/Plastics Tendon anastomosis Tendon anastomosis

8. Session Stations Basic knot-tying station Practice your one and two-handed ties Turkey Skin Suturing on a simple surface Can use this for the Flap sessions Sheep Lung Model for thick tissue (thanks to John Evans) Practice deep sutures, follow the curve, don’t “hork” Pig Hocks Tendon suturing and thick skin suturing

9. Evaluation You will be evaluated by: How well you tie knots. Ensure that an evaluator observes you tying slick, quick one and two-handed knots How well you suture Technique (holding the instrument, trajectory of needle, economy of movement and accuracy [placement, spacing etc]) Technique (holding the instrument, trajectory of needle, economy of movement and accuracy [placement, spacing etc]) How much and how well you get stuff done PGYIIs, by your ability to supervise??

10. The One Handed Knot -Step 1

11. The One Handed Knot -Step 2

12. The One Handed Knot -Step 3

13. The One Handed Knot -Step 4

14. The One Handed Knot -Step 5

15. The One Handed Knot -Step 6

16. The One Handed Knot -Step 7

17. The One Handed Knot -Step 8

18. The One Handed Knot -Step 9

19. The One Handed Knot -Step 10

20. The Two-Handed Knot -Step 1

21. The Two-Handed Knot -Step 2

22. The Two-Handed Knot -Step 3

23. The Two-Handed Knot -Step 4

24. The Two-Handed Knot -Step 5

25. The Two-Handed Knot -Step 6

26. The Two-Handed Knot -Step 7

27. The Two-Handed Knot -Step 8

28. The Two-Handed Knot -Step 9

29. The Two-Handed Knot -Step 10

30. The Two-Handed Knot -Step 11

31. The Two-Handed Knot -Step 12

32. The Two-Handed Knot -Step 13

33. The Two-Handed Knot -Step 14

34. Z-Plasty

35. Limberg Flap

36. V-Y Advancement Flap

37. Tendon Repair Stitch

38. Resources for self-directed learning The web Many videos already made on how to tie surgical knots (one and two handed and instrument ties) Many videos already made on how to tie surgical 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: http://video.google.ca/videoplay?docid=849977441 9188060835&q=surgical+knot+tying&ei=Vn- XSKTVEYXS-gHYru2gBg&hl=en