Emergency Wound Care And Suturing Louis Morales, Jr., MD

Objectives Care of wounds Methods in optimizing final wound closure Suture techniques, knot tying

Why Learn to Suture

Faced With a Wound Assess extent of wound Local anesthetic Cleanse wound Decide what mode of closure would be feasible Knife laceration

Treating Wounds Assess wound – dirty vs clean Dirty – falling into manure, human bite, etc. Debridement – remove debris Soap and water okay but rinse well Wound cleansing – Betadine or Prepodyne Hydrogen Peroxide initially but not long term

Modes of Wound Closure Sutures Steri-Strips (Butterfly tape) Skin Stapler Skin adhesive (glue)

Suture Wound Closure Necessary Instruments – forceps, needle holder, hemostat, sutures) Local anesthetic – Lidocaine with epi Gauze dressings, Ace bandage, etc. Meds: Narcotics, antibiotics, epinephrine, ointment

Minor Lacerations Debride if necessary Trim edges of skin as needed If contaminated then irrigate under pressure If deep, then place subdermal stitches Approximate skin margins using smallest stitch possible

Bites Debride as necessary Interrupted permanent stitches as infection is a possibility Antibiotics for Cat bites and Human bites If seen late, may have to heal by secondary intention

Post Repair Care Stitches should be removed from skin within 5-10 days depending on area Use immobilization or Steri-Strips for 3 months If Skin staples used must remove sooner

Principles of Wound Closure Gently handle tissues Take small tissue “ bites ” Lightly approximate tissues Use smallest suture possible

Using the Instruments Hold the forceps in your nondominant hand Hold the scissors in your thumb and ring finger, stabilize the tip with your index finger

Using the Instruments Hold the needle driver with your thumb and ring finger Use your index finger to stabilize the needle driver tip

Using the Instruments Hold the scalpel like a pencil or paint brush

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 needle

Suture Workshop – Pig Flanks

Simple Suture Remember that forceps should not strangulate tissues

Simple Suture

Deep Buried Suture

‘ Baseball ’ Stitch

Skin Adhesives Dermabond – Quick drying medical adhesive Can use cyanoacrylate (crazy glue) Apply 2 light coats a few minutes apart Avoid contact with the eyes

Surgical Tape It is important to keep Steri-Strips on for at least 3 months to decrease stretching of scar

When do you Remove Sutures? Rule of thumb: Face: 3-4 days Scalp: 5 days Trunk: 7 days Arm or leg: 7-10 days Hand or foot days

Summary – What’s in Your Pack Instruments for suturing – basic – hemostat, needle holder, forceps with teeth, scissors Sutures Local anesthetic – injection, spray, gel Steri-strips Skin glue – cyanoacrylate