1. Suturing Workshop Dr Samantha Murton MBChB Otago, FRNZCGP Registrar Training September 1 st 2011 Auckland

2. Preparation The 12 things you need Drawing Langers lines Margins – Naevi, benign appearing 1-2mm - BCC 3-5mm - SCC 5-10mm - Melanoma 5 – 20mm

4. Anaesthesia 1% lignocaine with 1:100,000 adrenaline, variety of others No adrenaline on digits 7 minutes to full effect of adrenaline

5. Elliptical excision The shape of the hull of a boat Try to get a good amount of fat under lesion

6. Suture Material Absorbable and non-absorbable 3.0 to 6.0 How long to leave it in – Face 5 days – Neck/scalp 5-7 days – Trunk 7 – 10 days – Back and limbs 10 – 14 days

7. Types of Suturing Styles Interrupted Continuous Mattress Subcuticular

8. How to Make it look good

9. Subcuticular Use absorbable suture Evert the skin

10. Deep Sutures Most wounds could do with them Helps with haemostasis Takes tension off skin Absorbable suture Bury the knot

11. Dressing Steristrips along wound take the tension off Some may require pressure dressing for a couple of days Skin adhesive may help with dressings to stick Micropore Suture guide/care of wound guide

12. Rhomboid Flap Good on back or places where adequate tissue to move and big lesion to excise Make sure well marked out No tension on wound Close flap wound first then defect Continuous suture