Advanced Skills in Athletic Training—
Wound Closure & Suturing
Dr. Carolyn Smith, MD
Associate Clinical Faculty
Marquette University Athletic Training Education Program
Team Physician
Marquette University Women’s Basketball
Keith Owsley, MS, ATC, LAT, CSCS
Assistant Clinical Faculty/Clinical Education Coordinator
Marquette University Athletic Training Education Program
Disclaimer
The views expressed in this presentation and discussion are
our own
Our comments or views may not be the same as our
employer and do not reflect those of Marquette University
or the Marquette Athletic Training Education Program
We have received no monetary benefit from any vendor or
manufacturer who may be mentioned or presented.
Learning objectives
Provide current CAATE information regarding suturing
skill set for athletic trainers.
Discuss and review state AT license as it relates to
advanced skills for athletic trainers
Review the various types of wounds encountered in AT
Review and discuss the various methods for wound
closure
Learning objectives
Discuss and review the decision process of suture vs
non-suture for wounds
Provide information and discuss challenges with
anesthesia for suturing and various types of
anesthesia used in suturing
Provide demonstration and hands on practice with
interrupted simple suturing
CAATE update on skill set
2020 CAATE standards…
ATEP programs allowed to teach advanced
skills within the standards
State practice act compliance where the
program is housed
ONLY joint dislocation reduction is a
required component of an AT program
CAATE update on skill set
2020 CAATE standards…
Programs may choose to include other
skills, but are not required
Teaching these components is already a
common practice in many programs
CAATE update on skill set
2020 CAATE standards…
How does that impact us as practicing clinicians?
Language in state license act dictates your ability to perform these skills
Current language in WI won’t allow most of these.
This may change in the future
May be different if an AT goes to a different state
State licensure and advanced skills
Ability to perform advanced skills will vary
state to state depending on language
Wisconsin licensure language is pretty open
ended—by design!
However—we will most likely be limited by
our state license!
State licensure and advanced skills
Could depend on approval of team
physician…however…
Physician signature may be going away!??
One issue…medications needed for
anesthesia!
Lidocaine/Epinephrine
Goals of Laceration Repair
Achieve homeostasis
Obtain optimal cosmetic results
Minimize risk of infection
Decision—suture or no suture
Wound edges cannot be approximated w/steristrips; dermal adhesive
Injury located in area of high tension
Closing dead space; can’t be accomplished with adhesive strips/dermal adhesive
Full thickness laceration—beyond the dermis level
Best healing= within 12 hours of injury
To Refer or Not To Refer
Deep wounds of unknown depth of penetration
Full thickness lacerations of eyelids, lips, or ears; any eyelid margin involvement
Injuries involving tendons, nerves or muscles of hand
Injuries involving nerves, larger arteries, joints or tendons
Markedly contaminated wounds
Cosmetic concerns w/wound healing
Anesthesia options
Injectable—
1% lidocaine; numbing occurs within 2-3 minutes; lasts up to two hours
Topical—
Lidocaine/epinephrine/tetracaine solution or gel; onset within 20 to 30 minutes; lasts 60 minutes
Lidocaine/prilocaine cream (EMLA); onset peaks within 60 minutes; lasts 1 to 4 hours
NOT approved by US FDA for non-intact skin despite regular use
The “other” topical—
ICE!—numbs the area as well as constricts for bleeding control
Various wound
closure options
Sutures
Choose smallest suture size that provides adequate strength and approximation
Non-absorbable
Nylon
Suture supplies necessary
Suture tray kit
Sterile tray—instruments; syringe; sterile drape; sterile gauze
Nylon suture
Not included in tray
Sizes
5-0 or 6-0 for face
4-0 – 5-0 for most other areas
3-0 – 4-0 for scalp
Timing of Suture Removal
Wound location Timing of removal (days)
Face 3 to 5
Scalp 7 to 10
Arms 7 to 10
Trunk 10 to 14
Legs 10 to 14
Hands or feet 10 to 14
Palms or soles 14 to 21
Demo of interrupted sutures
https://www.youtube.com/watch?v=pGEJEUZFIEk&t=175s
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