Lembert Suture Pattern

[Music] To construct the Lembert suture pattern, and all of the suture patterns used for viscera, you will need this portion of the DASIE which is the facsimile of the piece of bowel. Obviously these suture patterns can also be used in other viscera such as the bladder, the uterus. But they are used for viscera and the Lembert, the Connell, the Cushing, are all inverting suture patterns and so they’re very difficult to practice on the skin portion of the DASIE. Much easier to practice on the intestinal portion of the DASIE. The biggest problem with the intestinal portion of the DASIE is that its somewhat flimsy and it’s very thin. The wall is very thin. And so to differentiate between penetrating and non-penetrating sutures is somewhat difficult. What’s important for this course and in life: you should remember that obviously there is a difference between a penetrating suture that penetrates the lumen and potentially tracts bacteria and digesta through the suture pattern, versus a non-penetrating suture pattern, and they’re constructed somewhat differently. Obviously the difference being the depth of penetration of your bite. As I discussed in other portions of these video segments, to begin a continuous pattern, you can begin with a simple interrupted bite and then perform the continuous pattern of choice thereafter. With a Lembert you could begin with a Lembert suture as well. And so we’ll begin this continuous pattern somewhat different than others, but remember that you can always for the sake of this course or in life begin any continuous pattern generally with a simple interrupted suture construct. Here I’m going perform a Lembert at the beginning and I’m going to tie and then we’re going to perform a continuous Lembert suture pattern. The Lembert is a vertically oriented suture pattern very similar to the vertical orientation for instance with the Vertical Mattress. You’re going to go into the intestinal wall and out of the intestinal wall on the same side of the incision. Reset your needle. And then on the other side, the far side, you’re going to go into the intestinal wall and out of the intestinal wall. This is a non-penetrating suture. Notice I’m going to grasp and gather my suture and when I tie, and I’m going to tie purposely with a surgeons knot, to hopefully achieve the inversion that I intend with the suture pattern. Recall that the Lembert and some of the other intestinal suture patterns are inverting suture patterns and what you’re trying to achieve here is to get serosa to serosa contact. So I’ve created a Lembert suture to start this continuous Lembert pattern. I will use an assistant to maintain even tension on my suture as I construct this continuous Lembert. So now simply I repeat the process for as long as I need to. I’m going to take a bite. You can see how inverted this is. I’m going to take a bite into the intestinal wall and out of the intestinal wall on the near side of the incision. And in a similar fashion go into the intestinal wall and out of the intestinal wall on the far side of the incision. And we’ll take more bites just for practice. I’m deliberately trying not to penetrate the lumen. And then to end this pattern, I’m going to reverse and I’m going to, in backhanded fashion, take my final Lembert suture bite on each side, or my final bite on each side, and tie back to the loop. So this was a continuous Lembert, started by performing a Lembert suture and ending by performing a Lembert suture. And just to demonstrate you can see that this has inverted a substantial amount of the intestinal wall. [Music]

Leave a Reply

(*) Required, Your email will not be published