Wound management, local anaesthesia and suturing

Anisha Sukha FY1 doctor

Basics of wound healing

Local anaesthesia

Suturing materials

Practical example

Objectives

What is it?◦ Three phases: inflammatory, proliferative,

remodelling

Regeneration vs Repair

Wound closure◦ Primary vs secondary

Scarring

Wound healing

Mechanism of action Surface (e.g. Emla) Nerve Block Infiltration

◦ With or without adrenaline◦ Maximum doses◦ Unwanted effects◦ Contraindications

IV regional anaesthesia (Bier’s block)

Local Anaesthesia

Site Size Shape Surface Surroundings Edges Damage to underlying structures Nerve Damage Vascular damage Evidence of infection Evidence of retained material

Describing Wounds

What are you worried about?

Some examples

What type of ulcer?

Some examples

A 40 year old gentleman is brought into accident and emergency

At 09:00 he was washing his car when someone ran past and attacked him with a knife

He is brought in by ambulance He is haemodynamically stable and sat up

and talking to you in accident and emergency

What do you do?

Practical Example 1

A gentleman is 5 days post op following an emergency laparotomy for a perforated duodenal ulcer

The nurses request you see this gentleman because he is pyrexial

He is complaining of pain from the wound site but he is otherwise asymptomatic

What do you do?

Practical Example 2

Arterial ulcers Venous ulcers

(…see handout)

Diabetic ulcers

Other wounds to think about

Absorbable vs non-absorbable◦ Natural vs synthetic

Size

Needle Holder

Scissors

Forceps

Suturing materials

Questions?