Suturing WorkshopDr Samantha Murton

MBChB Otago, FRNZCGP

Registrar TrainingSeptember 1st 2011

Auckland

Preparation

• The 12 things you need• Drawing• Langers lines• Margins – Naevi, benign appearing 1-2mm - BCC 3-5mm - SCC 5-10mm - Melanoma 5 – 20mm

Anaesthesia

• 1% lignocaine with 1:100,000 adrenaline, variety of others

• No adrenaline on digits• 7 minutes to full effect of adrenaline

Elliptical excision

• The shape of the hull of a boat• Try to get a good amount of fat under lesion

Suture Material

• Absorbable and non-absorbable• 3.0 to 6.0• How long to leave it in– Face 5 days– Neck/scalp 5-7 days– Trunk 7 – 10 days– Back and limbs 10 – 14 days

Types of Suturing Styles

• Interrupted• Continuous• Mattress• Subcuticular

How to Make it look good

Subcuticular

• Use absorbable suture• Evert the skin

Deep Sutures

• Most wounds could do with them• Helps with haemostasis• Takes tension off skin• Absorbable suture• Bury the knot

Dressing

• Steristrips along wound take the tension off• Some may require pressure dressing for a

couple of days• Skin adhesive may help with dressings to stick• Micropore• Suture guide/care of wound guide

Rhomboid Flap

• Good on back or places where adequate tissue to move and big lesion to excise

• Make sure well marked out • No tension on wound• Close flap wound first then defect• Continuous suture