Suture Workshop

Bryan Combs, MSN, CRNP, FNP-BC, CNL, ATCUniversity of Alabama at Birmingham

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

Overview

• 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

Anatomy

DEEP FASCIA

PERCUTANEOUS

Wound Healing

Wound Healing

Infiltration and Anesthesia

Infiltration and Anesthesia

Infiltration and Anesthesia

Infiltration and Anesthesia

Infiltration and Anesthesia

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

Irrigation & Cleansing

Irrigation & Cleansing

Closure Basics

Some text say this is wrong

And this is correct

Closure Basics

Some text say this is wrong

And this is correct

I say what is most

comfortable

Closure BasicsRemember Back 1/3 and perpendicular

Clos

ure

Basi

cs

Closure Basics

The index finger is important with scissors and provides steadiness and precision

Clos

ure

Basi

cs

Closure Basics

Clos

ure

Basi

cs

Closure Basics

A Cutting Needle has Cutting Edge on Inside of needle

Reverse Cutting NeedleCutting Edge on

Outside

Tapered Needle

Excisions

Excisions

Excisions

Basic Repair• Layer Matching– Stay level as

needle advances from one side of wound to other

Basic Repair• Wound Edge

Eversion – Point of

needle needs to be 90-degree angle when piercing skin

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

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

Simple Suture

Simple Suture

1st – wrap suture clockwise

around needle holder 3 times

Simple Suture

2nd – grab the end of the

“pig tail” and pull to the pig

across the street

Simple Suture

Simple Suture

3rd – wrap suture counter

clockwise around the needle

holder 1 time

Simple Suture

4th – grab the end of the “pig

tail” and pull to the pig across

the street

Simple Suture

Simple Suture

5th – wrap suture clockwise

around the needle holder 1

time

Simple Suture

6th – grab the end of the “pig

tail” and pull to the pig across

the street

Simple Suture

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

Instrument Knot Tie

https://www.youtube.com/watch?v=wbpQhiNDxvo

Simple Suture

https://www.youtube.com/watch?v=SYNHSDI69kk

Verti

cal M

attre

ss

Vertical Mattress

https://www.youtube.com/watch?v=UV-j1zxckXA

Hor

izont

al M

attre

ss

Horizontal Mattress

https://www.youtube.com/watch?v=8QYEXw76CPE

Dee

p Su

ture

Runn

ing

Sutu

re

Running Mattress

https://www.youtube.com/watch?v=ODZtJL_gb4E

Subc

uticu

lar

Runn

ing

Sutu

re

Subcuticular Running Mattress

https://www.youtube.com/watch?v=iYts9c6Jrx8

Pull Out Dermal Suture

Beveled Edge or Wound

You have to get a bigger bite on beveled side

Dealing with Corners

Dealing with Corners

Parallel Lacerations

PRACTICE MAKES PERFECT

PRACTICE, PRACTICE, PRACTICE

Find a way to Practice

• All kinds of ways to practice–Eggplant–Meat with skin–Purchase mold device–Make your own•Be creative

References

• Trott, A. (2012), Wounds and Lacerations• Campo, T. and Lafferty, K. (2011), Essential

Procedures for Practitioners in Emergency, Urgent, and Primary Care Settings