Download - Basic suturing workshop
Basic Suturing Workshop
For Family Practitioner
students
Overview
• Wound evaluation & prep• Local anesthesia• Suture selection• Suturing techniques• Staples• Dermabond
ObjectivesThe participant will be able to :1. Discuss the principles and management of
wound repair.
2. Explain local anesthesia concepts, pharmacology and possible complications.
3. Perform simple interrupted suture technique.
4. discuss suture material choices and wound healing processes
Wound Management
• Anesthesia• Preparation• Sutures• Suture techniques
Skin Anatomy
• Epidermis• Dermis• Subcutaneous
Types of LacerationsSimple, Stellate, Avulsive, and Contused
Wound Status
• Clean• Contaminated• Delay
-Extremity – 12 hours-Face – 24 hours
Wound Evaluation
• Viability of tissue• Tissue loss• Depth of injury• Associated injuries
Foreign bodies on X-ray
• Pebbles• Paperclip• Windshield glass• Wood• Needle• Light bulb glass• Dark glass• Transparent glass
Don’t put your finger in!
FB Removal
Wound Cleansing Preparation• Hand washing• Hair removal• Anesthesia• Removal of gross foreign material• Immersion/soaking• Irrigation
Practical Suture Hints
• Comfort for you and patient• Adequate lighting• Usually sew toward yourself• Where to begin? Side of wound, middle,• landmarks• Flap? – enter flap first
Instruments
• Suture with needle• Needle holder• Forceps• Scissors• Hemostats
Anesthesia
• 1% LidocaineBlocks pain stimuli leaves pressure & touch sensation intact
• 2% LidocaineBlocks all awareness of stimuli including pressure & touch
Local Anesthetic Guidelines
• Never allow patient to view injection
• Always aspirate before injection
• Begin with topical dripping of med
• Inject within wound
Wound Cleansing
Method Mechanical cleansing Irrigation Debridement
Solutions NSS Betadine Hydrogen peroxide Shur Cleans
Wound Irrigation
• NSS 100-300 ml preferred• Most effective to remove debride• Use splash shield or 4X4 gauze• High volume• Low pressure
Suture Selection
• Small needles – fine repairs, e.g. face• Larger needles – bigger bites• More zeros (6-0) – smaller, thin suture• Smaller suture – less tensile strength
Suture Classifications
• Absorbable Chromic, Vicryl, Dexon Digested by body enzymes or Hydrolyzed by tissue fluids• Non-absorbable Ethilon, Monosof, Prolene, Silk Encapsulated or walled off
Absorbable Suture
• Chromic, Dexon, Vicryl• Below the skin• Special areas – inside the mouth• Situations where later removal difficult• Eliminate trauma of suture removal
Non-Absorbable
• Nylon/Ethilon• Prolene – hairy or keloid prone areas• Silk
Suture Selection
• Scalp 4-0 (blue)• Face 6-0• Back/Torso 3-0 or 4-0• Extremities 4-0 or 5-0
Wound Eversion
Wound Eversion
Best cosmetic results
• Smallest size needle• Monofilament• Good wound eversion
Skin Suture Placement
• Close wound in segments• Sutures equidistant from skin edge on either side• of wound• Evert skin edges• Wound margins loosely approximated• Repeatedly bisect the wound
“Wound edges should beapproximated, not strangulated!”
• Too tight = tissue necrosis• Too loose = edges not aligned
Knot Security
• Chromic 2-3 knots• Prolene 4-5 knots• Ethilon 3-4 knots
Key Steps
• Initiate tie with surgeon’s knot• Tighten the knot so it lays flat• Second throw in opposite direction• Two additional throws to secure knot
Suture Removal
• Face/Neck 3 - 5 days• Scalp 7 – 10 days• Joints 10 - 14 days• Back/Feet 10 - 14 days
Steri-strips
• Helpful for surface laceration• Non-motion areas• Avoid areas prone to getting wet• Can use with sutures or derma bond• Use Benzoin to provide additional adhesive
Tissue Glue Key Points
• Identify appropriate wound type• Cleanse and dry wound area• Apply three or four layers of tissue glue• Dry between each layer to bond skin edges
Dermabond• Possible for 1/3 of ED visits• Low tension areas e.g. face, trunk• Children, facial lacerations• Straight, superficial lacerations
Dermabond safety
• Moist gauze over eye• Trendelenburg position