-: This is Richard Allen at oculosurg.com
This video demonstrates a knotless suturing technique
with polypropylene suture.
I actually stole this idea from the cataract doctors.
I was watching a lecture on the Yamane technique,
and the surgeon used a thermal cautery
to make a flange on the end of the polypropylene haptics.
I thought, well, that was interesting.
The video demonstrates a similar technique
with skin suturing.
The suturing is performed through the skin,
but rather than tying a knot, a thermal cautery is used
to melt the suture.
The knob of molten polypropylene is then flattened
with a needle holder.
This holds the suture in position,
and the suturing then proceeds as normal.
At the end of the suturing,
the suture is fixated at the exit from the skin,
and the cautery is performed again.
A high- or low-temperature cautery can be used.
In this video, a high-temperature cautery is used.
I believe the low-temperature cautery
gives a little more control.
This procedure obviates tying knots,
which can sometimes distort the wound.
A Burow's triangle is then excised medially,
and the single knot is used to close this area.
The technique is then performed again.
The cautery should not touch the suture,
but get close to it.
The closer to the suture, obviously,
the faster it will heat up.
The needle holder is then used to flatten the flange.
Again, using the thermal cautery,
the suture is heated
and this is controlled to the area
of the exit of the suture with forceps.
The needle holder can then flatten the flange
to give it more surface area.
Antibiotic ointment is then placed over the area.
Postoperatively, the flange appears sturdy.
The suture can be cut at one of the flanges,
and then pulled out from the remaining flange.