Day 39 Dalaguete, Philippines #DPC Suture, IVTT

I went back to the ward again today. Not too much happened there. Just the usual IVTT's, vitals, passing meds, etc. I did, however, learn how to stitch! The doctor that told me he would teach me how was back today so I bought a pig thigh and he taught me. He let me use old surgical equipment and expired suturing thread. It's not hard learning how – it's hard doing it right. My left hand is fairly weak and has poor dexterity so using the picking forceps with that hand felt awkward. Although there are specific tools used for suturing, supplies here are short, and you have to make do with what is available. I was taught a simple interrupted stitch using a picking forcep and a straight hemostatic forcep. Here's how:

1. Use the picking forcep (with your non-dominant hand) to grasp the piece of flesh you will use as the initial entry point for the needle.
   
2. Take the straight forcep (in your dominant hand) and grasp the needle. Introduce the needle into the flesh you're holding with the picking forceps.
   
3. Grab the piece of flesh (again with the picking forceps) you wish to suture and introduce the needle using the straight forcep.
   
4. Pull the thread until most of it is on the opposite side you introduced the needle.
   
5. To tie off a simple interrupted stitch, loop the side with the most thread around the nose of the straight forcep 2-3 times then grasp the short end of the thread and pull through.
   
6. Cut the excess thread.
   
7. Repeat.

Using the picking forcep was very difficult for me so the doctor said I could just use my hand to make it easier and to strengthen my left hand to improve dexterity. Also, how hard to tie off the knots and how to maintain spacing between stitches (roughly 1cm for most wounds) requires practice. You don't want to tie off too hard because that can end up pinching the skin. Tie off to weak and the stitch falls apart. After the stitching, we had a super delicious dinner!
Anyway, here's some footage: