Basic suturing workshop


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Basic suturing workshop

  1. 1. Basic Suturing Workshop ForFamily Practitioner students
  2. 2. Overview• Wound evaluation & prep• Local anesthesia• Suture selection• Suturing techniques• Staples• Dermabond
  3. 3. 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
  4. 4. Wound Management• Anesthesia• Preparation• Sutures• Suture techniques
  5. 5. Skin Anatomy• Epidermis• Dermis• Subcutaneous
  6. 6. Types of LacerationsSimple, Stellate, Avulsive, and Contused
  7. 7. Wound Status• Clean• Contaminated• Delay -Extremity – 12 hours -Face – 24 hours
  8. 8. Wound Evaluation• Viability of tissue• Tissue loss• Depth of injury• Associated injuries
  9. 9. Foreign bodies on X-ray• Pebbles• Paperclip• Windshield glass• Wood• Needle• Light bulb glass• Dark glass• Transparent glass
  10. 10. Don’t put your finger in!
  11. 11. FB Removal
  12. 12. Wound Cleansing Preparation• Hand washing• Hair removal• Anesthesia• Removal of gross foreign material• Immersion/soaking• Irrigation
  13. 13. 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
  14. 14. Instruments• Suture with needle• Needle holder• Forceps• Scissors• Hemostats
  15. 15. Anesthesia• 1% LidocaineBlocks pain stimuli leaves pressure & touch sensationintact• 2% LidocaineBlocks all awareness of stimuli including pressure &touch
  16. 16. Guidelines• Never allow patient to view injection• Always aspirate before injection• Begin with topical dripping of med• Inject within wound
  17. 17. Wound Cleansing Method Mechanical cleansing Irrigation Debridement Solutions NSS Betadine Hydrogen peroxide Shur Cleans
  18. 18. Wound Irrigation• NSS 100-300 ml preferred• Most effective to remove debride• Use splash shield or 4X4 gauze• High volume• Low pressure
  19. 19. 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
  20. 20. 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
  21. 21. Absorbable Suture• Chromic, Dexon, Vicryl• Below the skin• Special areas – inside the mouth• Situations where later removal difficult• Eliminate trauma of suture removal
  22. 22. Non-Absorbable• Nylon/Ethilon• Prolene – hairy or keloid prone areas• Silk
  23. 23. Suture Selection• Scalp 4-0 (blue)• Face 6-0• Back/Torso 3-0 or 4-0• Extremities 4-0 or 5-0
  24. 24. Wound Eversion
  25. 25. Wound Eversion
  26. 26. Best cosmetic results• Smallest size needle• Monofilament• Good wound eversion
  27. 27. 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
  28. 28. “Wound edges should be approximated, not strangulated!”• Too tight = tissue necrosis• Too loose = edges not aligned
  29. 29. Knot Security• Chromic 2-3 knots• Prolene 4-5 knots• Ethilon 3-4 knots
  30. 30. 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
  31. 31. Suture Removal• Face/Neck 3 - 5 days• Scalp 7 – 10 days• Joints 10 - 14 days• Back/Feet 10 - 14 days
  32. 32. 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
  33. 33. 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
  34. 34. Dermabond• Possible for 1/3 of ED visits• Low tension areas e.g. face, trunk• Children, facial lacerations• Straight, superficial lacerations
  35. 35. Dermabond safety• Moist gauze over eye• Trendelenburg position