Basic suturing workshop

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  • 1.Basic Suturing WorkshopForFamily Practitioner students

2. Overview Wound evaluation & prep Local anesthesia Suture selection Suturing techniques Staples Dermabond 3. ObjectivesThe participant will be able to :1. Discuss the principles and management of wound repair.2. Explain local anesthesia concepts, pharmacology and possible complications.3. Perform simple interrupted suture technique.4. discuss suture material choices and wound healing processes 4. Wound Management Anesthesia Preparation Sutures Suture techniques 5. Skin Anatomy Epidermis Dermis Subcutaneous 6. Types of LacerationsSimple, Stellate, Avulsive, and Contused 7. Wound Status Clean Contaminated Delay -Extremity 12 hours -Face 24 hours 8. Wound Evaluation Viability of tissue Tissue loss Depth of injury Associated injuries 9. Foreign bodies on X-ray Pebbles Paperclip Windshield glass Wood Needle Light bulb glass Dark glass Transparent glass 10. Dont put your finger in! 11. FB Removal 12. Wound Cleansing Preparation Hand washing Hair removal Anesthesia Removal of gross foreign material Immersion/soaking Irrigation 13. Practical Suture Hints Comfort for you and patient Adequate lighting Usually sew toward yourself Where to begin? Side of wound, middle, landmarks Flap? enter flap first 14. Instruments Suture with needle Needle holder Forceps Scissors Hemostats 15. Anesthesia 1% LidocaineBlocks pain stimuli leaves pressure & touch sensationintact 2% LidocaineBlocks all awareness of stimuli including pressure &touch 16. Guidelines Never allow patient to view injection Always aspirate before injection Begin with topical dripping of med Inject within wound 17. Wound Cleansing Method Mechanical cleansing Irrigation Debridement Solutions NSS BetadineHydrogen peroxideShur Cleans 18. Wound Irrigation NSS 100-300 ml preferred Most effective to remove debride Use splash shield or 4X4 gauze High volume Low pressure 19. Suture Selection Small needles fine repairs, e.g. face Larger needles bigger bites More zeros (6-0) smaller, thin suture Smaller suture less tensile strength 20. Suture Classifications AbsorbableChromic, Vicryl, DexonDigested by body enzymes orHydrolyzed by tissue fluids Non-absorbableEthilon, Monosof, Prolene, SilkEncapsulated or walled off 21. Absorbable Suture Chromic, Dexon, Vicryl Below the skin Special areas inside the mouth Situations where later removal difficult Eliminate trauma of suture removal 22. Non-Absorbable Nylon/Ethilon Prolene hairy or keloid prone areas Silk 23. Suture Selection Scalp 4-0 (blue) Face 6-0 Back/Torso 3-0 or 4-0 Extremities 4-0 or 5-0 24. Wound Eversion 25. Wound Eversion 26. Best cosmetic results Smallest size needle Monofilament Good wound eversion 27. Skin Suture Placement Close wound in segments Sutures equidistant from skin edge on either side of wound Evert skin edges Wound margins loosely approximated Repeatedly bisect the wound 28. Wound edges should be approximated, not strangulated! Too tight = tissue necrosis Too loose = edges not aligned 29. Knot Security Chromic 2-3 knots Prolene 4-5 knots Ethilon 3-4 knots 30. Key Steps Initiate tie with surgeons knot Tighten the knot so it lays flat Second throw in opposite direction Two additional throws to secure knot 31. Suture Removal Face/Neck 3 - 5 days Scalp 7 10 days Joints 10 - 14 days Back/Feet 10 - 14 days 32. Steri-strips Helpful for surface laceration Non-motion areas Avoid areas prone to getting wet Can use with sutures or derma bond Use Benzoin to provide additional adhesive 33. Tissue Glue Key Points Identify appropriate wound type Cleanse and dry wound area Apply three or four layers of tissue glue Dry between each layer to bond skin edges 34. Dermabond Possible for 1/3 of ED visits Low tension areas e.g. face, trunk Children, facial lacerations Straight, superficial lacerations 35. Dermabond safety Moist gauze over eye Trendelenburg position