And Suturing Louis Morales Jr MD Objectives C are of wounds Methods in optimizing final wound closure Suture techniques knot tying Why Learn to Suture Faced With a Wound Assess extent of wound ID: 597774
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Slide1
Emergency Wound CareAnd Suturing
Louis Morales, Jr., MDSlide2
Objectives
Care of woundsMethods in optimizing final wound closureSuture techniques, knot tyingSlide3
Why Learn to SutureSlide4
Faced With a Wound
Assess extent of woundLocal anestheticCleanse woundDecide what mode of closure would be feasible
Knife lacerationSlide5
Treating WoundsAssess wound – dirty
vs cleanDirty – falling into manure, human bite, etc.Debridement – remove debrisSoap and water okay but rinse wellWound cleansing –
Betadine or PrepodyneHydrogen Peroxide initially but not long termSlide6
Modes of Wound ClosureSutures
Steri-Strips (Butterfly tape)Skin StaplerSkin adhesive (glue)Slide7
Suture Wound ClosureNecessary Instruments – forceps
, needle holder, hemostat, sutures)Local anesthetic – Lidocaine with epi Gauze dressings, Ace bandage, etc.
Meds: Narcotics, antibiotics, epinephrine, ointmentSlide8
Minor Lacerations
Debride if necessaryTrim edges of skin as neededIf contaminated then irrigate under pressure
If deep, then place subdermal stitchesApproximate skin margins using smallest stitch possibleSlide9
BitesDebride as necessary
Interrupted permanent stitches as infection is a possibilityAntibiotics for Cat bites and Human bitesIf seen late, may have to heal by secondary intentionSlide10
Post Repair CareStitches should be removed from skin within 5-10 days depending on area
Use immobilization or Steri-Strips for 3 monthsIf Skin staples used must remove soonerSlide11
Principles of Wound Closure
Gently handle tissuesTake small tissue “
bites”Lightly approximate tissuesUse smallest suture possibleSlide12
Using the Instruments
Hold the forceps in your nondominant handHold the scissors in your thumb and ring finger, stabilize the tip with your index fingerSlide13
Using the Instruments
Hold the needle driver with your thumb and ring finger
Use your index finger to stabilize the needle driver tipSlide14
Using the Instruments
Hold the scalpel like a pencil or paint brushSlide15
Using the Instruments
Hold the needle one-third to one-half of the distance from the end to the point
Place needle
holder on flat
part of needleSlide16
Suture Workshop – Pig Flanks
Slide17
Simple Suture
Remember that
forceps should
not strangulate
tissuesSlide18
Simple SutureSlide19
Deep Buried SutureSlide20
‘Baseball’ StitchSlide21
Skin Adhesives
Dermabond – Quick drying medical adhesiveCan use cyanoacrylate (crazy glue)
Apply 2 light coats a few minutes apartAvoid contact with the eyesSlide22
Surgical Tape
It is important to keep
Steri
-Strips on for at least
3 months to decrease stretching of scarSlide23
When do you Remove Sutures?
Rule of thumb: Face: 3-4 daysScalp: 5 daysTrunk: 7 days
Arm or leg: 7-10 daysHand or foot 10-14 daysSlide24
Summary – What’s in Your PackInstruments for suturing – basic – hemostat, needle holder, forceps with teeth, scissors
Sutures Local anesthetic – injection, spray, gelSteri-stripsSkin glue – cyanoacrylate