1. Suture Workshop
Bryan Combs, MSN, CRNP, FNP-BC, CNL, ATC University of Alabama at Birmingham

2. Overview
For emergency provider average laceration is 1 cm. - 3 cm. (0.4 in. – 1.2 in.)
Infection most common complication
3.5% - 6.3% of lacerations
13% of lacerations were considered significantly contaminated
Most important step to prevent infection wound irrigation
95% of glass in wounds is radio-opaque and radiographs recommended

3. Overview Locations 51% - Face/Scalp 34% - upper extremity
Etiology
Blunt Object – 42%
Sharp (non-glass) – 34%
Glass – 13%
Bites
Dog – 3%
Human – 1%
Other – 2%
Locations
51% - Face/Scalp
34% - upper extremity
13% - lower extremity

4. Anatomy
PERCUTANEOUS
DEEP FASCIA

5. Wound Healing

6. Wound Healing

7. Infiltration and Anesthesia

8. Infiltration and Anesthesia

9. Infiltration and Anesthesia

10. Infiltration and Anesthesia

11. Infiltration and Anesthesia

12. Irrigation & Cleansing
The most important step
Providone-iodine solution (not scrub prep) most effective skin cleanser
Water or Saline best option for wound irrigation and debridement
Hydrogen peroxide not recommended due to more negative then positive effects
Never shave the eyebrow
Make sure to numb them first

13. Irrigation & Cleansing

14. Irrigation & Cleansing

15. Closure Basics
Some text say this is wrong
And this is correct

16. I say what is most comfortable
Closure Basics
I say what
is most comfortable
Some text say this is wrong
And this is correct

17. Closure Basics
Remember Back 1/3 and perpendicular

18. Closure Basics

19. Closure Basics
The index finger is important with scissors and provides steadiness and precision

20. Closure Basics

21. Closure Basics

22. Closure Basics

23. Closure Basics Tapered Needle Reverse Cutting Needle
Cutting Edge on Outside
A Cutting Needle has Cutting Edge on Inside of needle

24. Excisions

25. Excisions

26. Excisions

27. Basic Repair Layer Matching
Stay level as needle advances from one side of wound to other

28. Basic Repair Wound Edge Eversion
Point of needle needs to be 90-degree angle when piercing skin

29. Wound Tension
The farther sutures are apart the more tension on wound and skin
The closer sutures are together there is less tension on wound and skin

30. The Simple Suture Knot The knot is the crucial step in suturing
The way I remember: 3/1/1 and always opposite
1st – wrap suture clockwise around needle holder 3 times
2nd – grab the end of the “pig tail” and pull to the pig across the street
3rd – wrap suture counter clockwise around the needle holder 1 time
4th – grab the end of the “pig tail” and pull to the pig across the street
5th - wrap suture clockwise around the needle holder 1 time
6th - grab the end of the “pig tail” and pull to the pig across the street

31. Simple Suture

32. Simple Suture
1st – wrap suture clockwise around needle holder 3 times

33. Simple Suture
2nd – grab the end of the “pig tail” and pull to the pig across the street

34. Simple Suture

35. Simple Suture
3rd – wrap suture counter clockwise around the needle holder 1 time

36. Simple Suture
4th – grab the end of the “pig tail” and pull to the pig across the street

37. Simple Suture

38. Simple Suture
5th – wrap suture clockwise around the needle holder 1 time

39. Simple Suture
6th – grab the end of the “pig tail” and pull to the pig across the street

40. Simple Suture

41. Simple Suture
This examples only shows two knots but you will see three done most of the time.
The second knot is the most important in terms of locking it down

42. Instrument Knot Tie

43. Simple Suture

44. Vertical Mattress

45. Vertical Mattress

46. Horizontal Mattress

47. Horizontal Mattress

48. Deep Suture

49. Running Suture

50. Running Mattress

51. Subcuticular Running Suture

52. Subcuticular Running Mattress

53. Pull Out Dermal Suture

54. Beveled Edge or Wound
You have to get a bigger bite on beveled side

55. Dealing with Corners

56. Dealing with Corners

57. Parallel Lacerations

58. PRACTICE MAKES PERFECT PRACTICE, PRACTICE, PRACTICE

59. Find a way to Practice All kinds of ways to practice Eggplant
Meat with skin
Purchase mold device
Make your own
Be creative

60. References Trott, A. (2012), Wounds and Lacerations
Campo, T. and Lafferty, K. (2011), Essential Procedures for Practitioners in Emergency, Urgent, and Primary Care Settings