The Suturing Saga continues

Here you can see the lovely vaginas we cut out of our foam blocks to practice on. Notice that the eipisiotomy I cut is crooked. I’ve colored in the different layers: red = muscle layer, pink = submucosal, blue = subcutaneous, purple = subcuticular, and the edge is the mucocutaneous border. All so nice and neatly laid out: so NOT how it’s EVER going to look on a real woman, EVER.

sutureone

The red vagina on the left is my very first attempt at suturing. Maybe the second attempt will go more smoothly? I’ve begun my anchor stitch in the submucosal layer.

suture two

Here I’ve tied off my anchor stitch, using an instrument tie that took at least 10 minutes to complete. Putting in an anchor stitch first, before suturing anything else, is only done if there’s a lot of blood coming from the apex of the wound, and the stitch is meant to tie off the bleeding vessels and help keep the rest of the wound as clean and blood free as possible. In theory. Notice how loose and baggy my anchor stitch is. I don’t think that would stop even the smallest vessel from bleeding.

suture three

Having botched the anchor stitch, I now move on to the muscle layer. The muscle layer has got to be the hardest to stitch, period. It’s so deep! And the stitch is supposed to go sideways, so that you don’t end up stitching through the woman’s rectum. Piece of cake, lemme tell you…

suture four

Here you can see where my first interrupted stitch through the muscle layer tore through the foam, and managed to absolutely not approximate the muscle together in any way, whatsoever.

suture 6

My second interrupted stitch is a little better. At least it’s on both sides of the wound, ostensibly pulling the tissue together.

suture seven

Enough with the muscle layer already! Suturing mucosa is such a blessed relief, after all of that deep stuff. This is an interlocking blanket stitch, in theory.

suture eight

After suturing the mucosa above the hymenal ring, next comes a transitional stitch which dives under the hymenal ring, and comes up in the subcutaneous tissue in front of the hymenal ring. And then, what comes next is a descending continuous stitch down towards the perineal apex of the wound.

suture nine

The descending continuous stitch continues.

suture ten

After that, we sew our way back up the perineum, this time in the subcuticular layer, using a ladder stitch composed of interlocking C’s, if that makes any sense whatsoever. Trust me, it barely makes sense to me. Notice how taut and well approximated the subcutaneous layer is in the back *rolls eyes*. Honestly, though, how do you really do this on a live woman? If you draw up the sides of the wound together, how do you even get your needle in there to suture in the first place? Urgh, it defies me.

suture eleven

The finished product: well, it’s stitched up, at any rate. Not sure if it’s any good. Thank goodness this isn’t a live person yet!

suture twelve

Meanwhile, four more lacerated foam vaginas eagerly await my careful, skilled, well-controlled ministrations *snort*.

suture thirteen

OPEN LETTER TO THE WOMEN OF THE WORLD: Do not fear! I am practicing this like nobody’s business! I promise you, before I even come within an inch of your perineum, I will be so much better at this! I will suture foam until my fingers fall off, then I’ll progress to raw chicken breast, and when I finally do suture the very first of you, it will be under the watchful guidance of a skilled, experienced midwife, who won’t let me place a single stitch unless it’s in the absolute right place. I will be so careful. I will keep working on this until I’m good at it. I promise you.

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3 Comments

  1. Posted September 26, 2006 at 10:14 pm | Permalink

    as long as the edges come together, how it looks doesn’t matter much! it’s not like it’s embroidery. :)

    good work! :)

  2. k
    Posted September 26, 2006 at 11:46 pm | Permalink

    Bring on the chicken! Looks to me like you’ve got that foam stitched up within an inch of it’s life. ;)
    We mamas are a lot more patient and forgiving than you seem to give us credit for! I’ve survived a bad suture job (yes I looked, to cut them out as I tore them apart with a sneeze) and a good one. I believe the difference is that the second time, midwife explained why and where and how she was going to do it… It was needed, I argued for leaving things be. She explained why she didn’t want to leave it and why that was important for me.
    Both were 3 degree (? is this a term used universally) tears. Not so pleasant, but the second was a much easier healing.

  3. Posted September 27, 2006 at 7:46 am | Permalink

    The foam stitching is hilarious! I have every confidence that you’ll practice your fingers to the bone :-) My midwife likes to say that if you stick two pieces of perineum in a room together they’ll find eachother–the body is remarkably good at healing itself. Just wait until you come across a tear that needs stitching!

    I had a 2nd degree tear that my midwife stitched, it healed together beautifully except that a skin tag formed and remained irritated and tender until we tied it off–it baffled both of us… but life goes on!

    Suture on dear student :-)

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