Suture Basics
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Transcript of Suture Basics
Basic techniques
That somehow everyone doesn’t know
Wound care priorities
Discover and treat injuries to critical deep structure
Cover critical structures with skin Maintain function without contracture Prevent infection Cosmesis is a distant fifth priority
Basic techniques
Managing contaminated wounds Wound eversion Inverted dermal sutures as primary closure Instrument tying
Managing contaminated wounds
Never close an infected wound If wound merely contaminated, clean it up
and then make a decision for primary, secondary or tertiary (delayed primary closure)
Timing of delayed closure in contaminated wound
Managing contaminated wounds
Debride all dead or marginal tissue (if unsure cut a little, does it bleed?)
Remove all foreign debris When irrigation needed use either a
hydrostatic irrigator or a 10 cc syringe with an 18 ga angicath or Zerowet
Klenzalac irrigation tray
Managing contaminated wounds
If wound is over 6 hours old and exudative, prep it, then gram stain it for white cells and/or bacteria
Frequently, where there are no important structures and skin is loose enough to avoid tension, better simply to excise a dirty wound, then close it
Wound excisionScore skin in ellipse
Excise wound with scissors or scalpel
Undermine excised wound to allow eversion on closure
Evert to allow flat scar after healing
Use dermal stitches as primary closure allows natural eversion from technique tissue 1/2 life of about a month allows for
far longer support for healing than skin sutures
after dermal layer placed, often can close skin with rapid techniques (tapes, running suture, glue)
Wound is weakest when skin sutures are removed
Use dermal stitches as primary closure
Wound must be clean Technically a little more difficult than skin
sutures
Instrument tie
Surgeon’s knot Follow with at least three square throws Granny knots will lead to untieing
Driver in middle, two overhand throws
Grab loose tail
Cross hands to lay flat
Finish by
Placing needle driver between tails single overhand throw, grasp loose tail cross hands to lay flat at least 3 more throws