SuturingSuturing

Tanith D. Turner-LumbTanith D. Turner-LumbClinical Education ManagerClinical Education Manager

BRIBRI

Wound ClosureWound Closure

• Before the repair of wounds or Before the repair of wounds or lacerations is initiated, a thorough lacerations is initiated, a thorough evaluation of the patient must be evaluation of the patient must be completed. Wound characteristics, completed. Wound characteristics, anatomic site, and underlying anatomic site, and underlying conditions that affect the conditions that affect the management of every wound.management of every wound.

Wound ClosureWound Closure

There are 3 types of wound closure:There are 3 types of wound closure:

• Primary (Primary Intention)Primary (Primary Intention)

• Secondary (Secondary intention)Secondary (Secondary intention)

• Tertiary (Delayed Primary Closure)Tertiary (Delayed Primary Closure)

Contraindications for Suturing Contraindications for Suturing WoundsWounds

• Reddening/Oedema of wound marginsReddening/Oedema of wound margins

• Discharge or PusDischarge or Pus

• Fever or ToxeamiaFever or Toxeamia

• Puncture Wound/Animal BitePuncture Wound/Animal Bite

• Tendon/Nerve/Vessel InvolvementTendon/Nerve/Vessel Involvement

• Wounds ‘older’ than 12hours (after Wounds ‘older’ than 12hours (after injury) injury)

SuturesSutures

AbsorbableAbsorbable

Surgical GutSurgical Gut

DexonDexon

ChromicChromic

Non AbsorbableNon Absorbable

NylonNylon

ProleneProlene

BraidedBraided

Suture sizeSuture size

Sutures are measured by width or Sutures are measured by width or diameter.diameter.

• 6-0 (smallest)6-0 (smallest)

• 5-05-0

• 4-04-0

• 3-03-0

• 1-0 and 2-01-0 and 2-0

NeedlesNeedles

• Needle length is in millimetresNeedle length is in millimetres

• Needle shapes are generally classified by Needle shapes are generally classified by the degree of curvature of the body.the degree of curvature of the body.

• Taper PointTaper Point

• Blunt PointBlunt Point

• Conventional CuttingConventional Cutting

• Reverse CuttingReverse Cutting

TechniqueTechnique

• It is important that the wound is It is important that the wound is closed in equal ‘bites’ both closed in equal ‘bites’ both horizontally and vertically.horizontally and vertically.

• The wound edges should be slightly The wound edges should be slightly everted.everted.

TechniqueTechnique

• Hold the needle (with needle holder/driver) a Hold the needle (with needle holder/driver) a quarter distance from the blunt end.quarter distance from the blunt end.

• The needle should enter the skin with a ¼ inch The needle should enter the skin with a ¼ inch bite from wound edge at a 90 degree angle.bite from wound edge at a 90 degree angle.

TechniqueTechnique

• Release needle, reach into wound, grasp Release needle, reach into wound, grasp needle and pull free. (one side of the wound needle and pull free. (one side of the wound is ‘done’ at a time)is ‘done’ at a time)

• Using forceps, lightly grasp the skin edge and Using forceps, lightly grasp the skin edge and arc needle through opposite edge, inside the arc needle through opposite edge, inside the wound.wound.

• Release the needle, and grasp the protruding Release the needle, and grasp the protruding needle from the skin and pull through. (leave needle from the skin and pull through. (leave approx ½ to 1 inch protruding from bite sides)approx ½ to 1 inch protruding from bite sides)

TechniqueTechnique

• Release needle and wrap suture around Release needle and wrap suture around the needle holder 2 times.the needle holder 2 times.

• Grasp the ends of the suture material and Grasp the ends of the suture material and pull the 2 lines across wound site in pull the 2 lines across wound site in opposite directions. (this is called ‘a opposite directions. (this is called ‘a throw’)throw’)

• Repeat 3-4 times, but on each throw Repeat 3-4 times, but on each throw reverse the order of the wrap.reverse the order of the wrap.

• Cut ends of suture ¼ inch from knotCut ends of suture ¼ inch from knot• Do not position knot directly over the Do not position knot directly over the

wound edge.wound edge.

TechniqueTechnique

Suture RemovalSuture Removal

• Times will vary according to the location Times will vary according to the location and depth of the wound. However, the and depth of the wound. However, the average time frame is 7-10 days after average time frame is 7-10 days after application application

• FaceFace

• Body and ScalpBody and Scalp

• Soles, Palms, Back or Other JointsSoles, Palms, Back or Other Joints

• Any suture with pus or signs of infections Any suture with pus or signs of infections should be removed immediately. should be removed immediately.

Suture RemovalSuture Removal

• Using the tweezers, grasp the knot and Using the tweezers, grasp the knot and snip the suture below the knot with the snip the suture below the knot with the scissors as close as possible to the skin. scissors as close as possible to the skin.

• Pull the suture line through the tissue Pull the suture line through the tissue

• Once all sutures have been removed count Once all sutures have been removed count the sutures. the sutures.

• The number of sutures needs to match the The number of sutures needs to match the number indicated in the patient's health number indicated in the patient's health record.record.

Any QuestionsAny Questions