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Basic suturing workshop
- 1. Basic Suturing Workshop For Family Practitioner students
- 2. Overview • Wound evaluation & prep • Local anesthesia • Suture selection • Suturing techniques • Staples • Dermabond
- 3. Objectives The participant willbe 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 Lacerations Simple,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 onX-ray • Pebbles • Paperclip • Windshield glass • Wood • Needle • Light bulb glass • Dark glass • Transparent glass
- 10. Don’t put yourfinger in!
- 11.
- 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% Lidocaine Blockspain stimuli leaves pressure & touch sensation intact • 2% Lidocaine Blocks all awareness of stimuli including pressure & touch
- 16. Guidelines • Never allowpatient 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.
- 25.
- 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 shouldbe approximated, not strangulated!” • Too tight = tissue necrosis • Too loose = edges not aligned
- 29. Knot Security • Chromic2-3 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
- 32. Suture Removal • Face/Neck 3 - 5 days • Scalp 7 – 10 days • Joints 10 - 14 days • Back/Feet 10 - 14 days
- 33. 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
- 34. Tissue Glue KeyPoints • 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
- 35. Dermabond • Possible for 1/3 of ED visits • Low tension areas e.g. face, trunk • Children, facial lacerations • Straight, superficial lacerations
- 36. Dermabond safety • Moistgauze over eye • Trendelenburg position