Microsurgery Tutorials. Lesson 2: The Basics. Taking Your Skills Further

A series of tutorials on microsurgery, starting from the basics working up to more advanced techniques, uploaded in random order.
All videos: https://www.youtube.com/user/DrWmicrosurgery/videos
Any questions or comments are welcome at [email protected].

Copyright 2012 Victor Volovici (DrW).

Carl Zeiss Opmi Pico Microscope, various colour filters applied, magnification 20x.
Using the same technique as in lesson 1, we manage to sew up a leaf. This drill is a mere preamble to lesson 3, which will entail the handling of a tissue of extreme finesse, a flower petal.
The aspects that must be duly noted here are: the insertion of the needle. The microforceps must act as a counterforce to ease the needle in without too much damage to the tissue, one may pass through both edges in one move with experience, but it is advisable at first to pass the needle through each edge individually. The edges must again be only approximated. It is easier with a leaf and petal to see whether excess force is applied, as trainees will notice tearing through the tissue should they pull too hard on the thread.
We use 10-0 Nylon for this suture, but 9-0 may also be used, especially in the beginning.
We also illustrate several potential problems: in suture 2, the needle escapes the microneedle holder and we show what to do if such an event is to occur. Secondly, also in this suture, the bite from the proximal edge is too small and does not match the bite from the distal edge. This should be avoided. Also to be taken into account, as one can notice in the knot before last, if excess tension is applied the hole tends to enlarge. This should be kept in mind as a marker of error. Last but not least, when working with petal and leaf, the thread will be hard to pick up especially when tying the second knot. We show various ways of working around that without damage to the tissue. Choice of solution should be based on preference and handiness of each individual surgeon.
In the end, the suture is assessed at 10x and 6x with various colour filters.
More videos to come!
Song: Mozart Symphony number 40. I do not own or claim authorship for the song.