1. Basic Suturing Dr.zameer

2. Vertical Mattress Good for everting wound edges (neck, forehead creases, concave surfaces)

3. Vertical Mattress Stitch Promotes eversion of the skin. Tension or very thick skin. Enter wound on one side, pierce other side twice, and exit on side entered.

4. http://www.youtube.com/watch?v=824FhFUJ6wc

5. Horizontal Mattress Good for closing wound edges under high tension, and for hemostasis.

6. Vertical Mattress Stitch Promotes eversion of the skin. Tension or very thick skin. Enter wound on one side, pierce other side twice, and exit on side entered.

7. Horizontal Mattress http://www.youtube.com/watch?v=9DdaooEXshk

8. Suturing - finishing After sutures placed, clean the site with normal saline. Apply a small amount of Bacitracin or white petroleum and cover with a sterile non-adherent compression dressing (Tefla).

9. Suturing - before you go… Need for tetanus globulin and/or vaccine? – Dirty (playground nail) vs clean (kitchen knife) – Immunization history (>10 yrs need booster or >5 yrs if contaminated) Tell pt to return in one day for recheck, for signs of infection (redness, heat, pain, puss, etc), inadequate analgesia, or suture complications (suture strangulation or knot failure with possible wound dehiscence) It should be emphasized to patients that they return at the appropriate time for suture removal or complications may arise leading to further scarring or subsequent surgical removal of buried sutures.

10. Patient instructions and follow up care Wound care – After the first 24-48 hours, patients should gently wash the wound with soap and water, dry it carefully, apply topical antibiotic ointment, and replace the dressing/bandages. – Facial wounds generally only need topical antibiotic ointment without bandaging. – Eschar or scab formation should be avoided. – Sunscreen spf 30 should be applied to the wound to prevent subsequent hyperpigmentation.

11. Suture Removal Average time frame is 7 – 10 days – FACE: 3 – 5 d – NECK: 5 – 7 d – SCALP: 7 – 12 days – UPPER EXTREMITY, TRUNK: 10 – 14 days – LOWER EXTREMITY: 14 – 28 days – SOLES, PALMS, BACK OR OVER JOINTS: 10 days Any suture with pus or signs of infections should be removed immediately.

12. Suture Removal Clean with hydrogen peroxide to remove any crusting or dried blood Using the tweezers, grasp the knot and snip the suture below the knot, close to the skin Pull the suture line through the tissue- in the direction that keeps the wound closed - and place on a 4x4. Count them. Most wounds have < 15% of final wound strength after 2 wks, so steri-strips should be applied afterwards.