Post on 20-Oct-2020
2018/10/09
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Suture WorkshopReview and practice for clinical
efficiency in most settings ContosoP h a rm a c e u tic a ls
Jeremy Nelson
Meet your Facilitators
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Carol Gorney
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ObjectivesW hat to expect
WhatCom pare types, sizes,
style of suture m aterial/technique
WhyD iscuss the
appropriate situation for suture style and
type
HowD em onstrate
proficient skill at several suturing
techniques
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WhatWe suture in varius settings
Outpatient primary care
Urgent care
Retail care
Emergency care
Specialty care
Surgical care.
This is a bread and butter skill that some will do daily and others will do occasionally. This workshop should have value for all of you.
This will NOT be a detailed wound lecture
• Types of wounds • Facial• Deep and superficial• Cheek/zygoma• eyebrow
• Lip• Oral mucosa and tongue• Scalp• Ear• Corporal• Extremities• Overlying joints
• Genital/perineal
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• Silk
• Nylon (Ethilon, Dermalon)
• Polypropelene (Prolene, Surgilene)
• Polybutester (Novafil)
• Natural, easy to handle and tie
• Braided
• Monofilament
• high tensile strength
• min tissue rxn, cheap
• Synthetic plastic monofilament
• elastic properties
• comes in blue
• Synthetic monofilament
• More elastic, less suture marks
• Easy to handle
• Weakest tensile strength of non absorbables, Not common for minor wounds;Chesttubes/central lines
• unties, more knots required
• Unties more than nylon, expensive, loose after swelling recedes
• Unties more than nylon, expensive, loose after swelling recedes
Non Absorbable – used for most surface lacerations
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• Fast Absorbing Gut
• Chromic Gut
• Vicryl (polyglycolic acid)
• Vicryl Rapide
• Poliglecarprone 25 (Monocryl)
• Polyglycolic acid (Dexon)
• Polydioxoanone (PDS)
• Polyglyconate (Maxon)
• 4-6 days, weakest, unties
• Tissue rxns high
• 10-14 days, fair strength
• Most tissue reactivity
• 30 days,braided,strong
• Handles well, knot stable
• 7-10 days, braided,
• Min tiss rxn, mod strength
• 1-2weeks, handles easy
• Fair strength
• 30days, braid, high friction
• 5-6wks, mono, stiff
• 5-6wks, mono, pliable, strong
• Face, esp in combo w/ tape
• If removal difficulty expected
• Mouth, tongue, nailbed
• Deep, nailbed, mouth
• Face, scalp, under splint/cast
• Face, subcuticular
• Cosmetic, not for high tension
• Deep Closure
• Deep Closure
• Deep Closure
Absorbable Sutures
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Suture Selection at your discretion
• 19 trial Meta analysis (1748 patients) comparing non absorbable vs absorbable sutures in surgical and traumatic lacerations.
• Equivalent Cosmetic Outcomes
• No significant difference for wound infection or dehiscence• Follow up insufficient in several studies
• Suture material should be individualized for patients based upon clinical discretion.
• Absorbable vs Nonabsorbable Sutures for Skin Closure: A Meta-Analysis of Randomized Controlled Trials; Xu B, Xu B, Wang L, Chen C, Yilmaz TU, Zhang W, He B. Ann Plast Surg. 2016;76(5):598.
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Suturing techniques
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• Percutaneous Skin Closure• Superficial wounds, 1 layer closures
• Can use either absorbable or non absorbable sutures
• Simple interrupted• Verticle mattress• Horizontal mattress
• Figure of 8• Buried
• Simple Running• Simple Running Locking• Subcuticular Running
• Dermal Closure• Deeper wounds require closure to prevent• Abscess, hematoma, increased surface
wound tension
• Should use absorbable sutures
• Simple Buried• Buried Horizontal Mattress
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Simple InterruptedMost commonly used
Simple method of closing traumatic and surgical wounds
Needle penetrates at 90°
Equal width at base as surface
Width and depth equal on both sides
Width and depth determined by the wound location and dermal thickness.
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Simple BuriedDermal Closure
Use to decrease tension on percutaneous sutures to improve cosmesis
Prevent abscess/hematoma/fluid collectionBury the knot
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Vertical Mattress
“far far, near near”To decrease wound tension
To evert the edgesIf wound needs deep closure
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Horizontal Mattress
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Figure of 8/cruciate mattress
Hybrid suture. Decreases suture timePunch biopsy closure
Low tension wounds.
Secondarily used after deep sutures.
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Half Buried SutureGood for cornersCosmetic approach for less suture lines/scarsHairline
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Simple Running SutureGreat time saver.
Good for straight wound with little tensionAfter placing deep retention suturesBe sure to space evenly or it will make dimples and corners in the tissue.
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Running Locked Suture
• When the wound is under tension
• Lock (bring suture around the loop) before closing loop
• Can start with simple and lock as need, or continually for appearance.
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Subcuticular RunningCosmetic stitchWhen suture dimples or lines need to be avoidedBe careful about spacing or it will dimple the tissueBury the knot
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Demonstrations
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• https://youtu.be/TFwFMav_cpE• Duke University Suture Skills Course
https://youtu.be/TFwFMav_cpE
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Questions?
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Thank YouJeremy Nelson & Carol Gorney