There are several different techniques, so I wanted to illustrate a few of them. The common theme is start from above or below the chest tube and throw your first knot to the skin:
1) Wrapping technique (this is my go-to technique)
- begin by throwing your first knot into the skin above the tube, then wrap the suture material around the base of tube (at the level of the tube insertion site)multiple times and then tie into place
- this can be repeated from below the tube for extra security
2) The “ps and qs” technique (here called the easy L)
- essentially throw your first stitch in the skin and then perform 3 “p” stitches or 3 “q” stitches and vice versa
- finish by performing hand ties
- video: https://www.youtube.com/watch?v=Qsq1fPxYNrQ
3) The “big S” technique
- similar to a nautical knot, called the clove hitch
- essentially form an “S” shape underneath the chest tube (after you throw your first stitch)
- video: https://youtu.be/4lkyq7U6fpg
Other techniques include purse string sutures or horizontal mattress sutures.