Basic suturing workshop

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