Advanced Skills in Athletic Training—

Wound Closure & Suturing

Dr. Carolyn Smith, MD

Associate Clinical Faculty

Marquette University Athletic Training Education Program

Team Physician

Marquette University Women’s Basketball

Keith Owsley, MS, ATC, LAT, CSCS

Assistant Clinical Faculty/Clinical Education Coordinator

Marquette University Athletic Training Education Program

Disclaimer

The views expressed in this presentation and discussion are

our own

Our comments or views may not be the same as our

employer and do not reflect those of Marquette University

or the Marquette Athletic Training Education Program

We have received no monetary benefit from any vendor or

manufacturer who may be mentioned or presented.

Learning objectives

Provide current CAATE information regarding suturing

skill set for athletic trainers.

Discuss and review state AT license as it relates to

advanced skills for athletic trainers

Review the various types of wounds encountered in AT

Review and discuss the various methods for wound

closure

Learning objectives

Discuss and review the decision process of suture vs

non-suture for wounds

Provide information and discuss challenges with

anesthesia for suturing and various types of

anesthesia used in suturing

Provide demonstration and hands on practice with

interrupted simple suturing

CAATE update on skill set

2020 CAATE standards…

ATEP programs allowed to teach advanced

skills within the standards

State practice act compliance where the

program is housed

ONLY joint dislocation reduction is a

required component of an AT program

CAATE update on skill set

2020 CAATE standards…

Programs may choose to include other

skills, but are not required

Teaching these components is already a

common practice in many programs

CAATE update on skill set

2020 CAATE standards…

How does that impact us as practicing clinicians?

Language in state license act dictates your ability to perform these skills

Current language in WI won’t allow most of these.

This may change in the future

May be different if an AT goes to a different state

State licensure and advanced skills

Ability to perform advanced skills will vary

state to state depending on language

Wisconsin licensure language is pretty open

ended—by design!

However—we will most likely be limited by

our state license!

State licensure and advanced skills

Could depend on approval of team

physician…however…

Physician signature may be going away!??

One issue…medications needed for

anesthesia!

Lidocaine/Epinephrine

Goals of Laceration Repair

Achieve homeostasis

Obtain optimal cosmetic results

Minimize risk of infection

Types of

Wounds

Superficial (loss of

epidermis only)

Types of

Wounds

Partial thickness (involves the

epidermis and dermis)

Types of

Wounds

Full thickness

(involves dermis,

subcutaneous fat

and sometimes

bone/tendon

Decision—suture or no suture

Wound edges cannot be approximated w/steristrips; dermal adhesive

Injury located in area of high tension

Closing dead space; can’t be accomplished with adhesive strips/dermal adhesive

Full thickness laceration—beyond the dermis level

Best healing= within 12 hours of injury

To Refer or Not To Refer

Deep wounds of unknown depth of penetration

Full thickness lacerations of eyelids, lips, or ears; any eyelid margin involvement

Injuries involving tendons, nerves or muscles of hand

Injuries involving nerves, larger arteries, joints or tendons

Markedly contaminated wounds

Cosmetic concerns w/wound healing

Anesthesia options

Injectable—

1% lidocaine; numbing occurs within 2-3 minutes; lasts up to two hours

Topical—

Lidocaine/epinephrine/tetracaine solution or gel; onset within 20 to 30 minutes; lasts 60 minutes

Lidocaine/prilocaine cream (EMLA); onset peaks within 60 minutes; lasts 1 to 4 hours

NOT approved by US FDA for non-intact skin despite regular use

The “other” topical—

ICE!—numbs the area as well as constricts for bleeding control

Various wound

closure options

Adhesives

e.g. Dermabond,

Surgiseal

Various wound closure options

Steri-strips

Various wound

closure options

Staples

Various wound

closure options

Sutures

Choose smallest suture size that provides adequate strength and approximation

Non-absorbable

Nylon

Suture supplies necessary

Suture tray kit

Sterile tray—instruments; syringe; sterile drape; sterile gauze

Nylon suture

Not included in tray

Sizes

5-0 or 6-0 for face

4-0 – 5-0 for most other areas

3-0 – 4-0 for scalp

Timing of Suture Removal

Wound location Timing of removal (days)

Face 3 to 5

Scalp 7 to 10

Arms 7 to 10

Trunk 10 to 14

Legs 10 to 14

Hands or feet 10 to 14

Palms or soles 14 to 21

Demo of interrupted sutures

https://www.youtube.com/watch?v=pGEJEUZFIEk&t=175s

Let’s stitch!