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Suture Workshop Intermediate Skills. Chris Vincent Thursday, November 2, 2006. Topics. Instruments Type Handling Suture Material When to use Local Anesthesia Type Amount Wound Closure Undermine / Deep Vertical / Horizontal Mattress Sub / Intra cuticular. Instruments. Scalpel

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suture workshop intermediate skills

Suture Workshop Intermediate Skills

Chris Vincent

Thursday, November 2, 2006

topics
Topics
  • Instruments
    • Type
    • Handling
  • Suture
    • Material
    • When to use
  • Local Anesthesia
    • Type
    • Amount
  • Wound Closure
    • Undermine / Deep
    • Vertical / Horizontal Mattress
    • Sub / Intra cuticular
instruments
Instruments
  • Scalpel
    • #10, #11, #15
  • Forceps
    • With teeth
    • Without teeth (plain)
scalpel blades
Scalpel Blades

#10: Major Surgery, C-Section, Skin Paring

#11: I & D, “stab” wounds for drains, tubes

#15: Minor Skin, Plastic Surgery

forceps
Forceps

Plain: Use on peritoneum, mucosa

With Teeth: Use on skin

instrument handling10
Instrument Handling
  • Hold the instrument like you would hold a pen, pencil, or chop-sticks!!
suture
Suture
  • Needles
  • Material
  • Sizes
  • Special Cases
suture selection needles
Suture Selection – Needles
  • Cutting - for dermal, subcuticular or full skin thickness penetration
  • Tapered - for subcutaneous or organ wall closures

Tip – when in doubt ask for cutting

suture selection material
Suture Selection - Material
  • Subcuticular
    • Absorbable, braided
    • Vicryl or Dexon
    • Usually 2-0 to 4-0
  • External (skin surface)
    • Usually non-absorbable, monofilament to reduce tissue reactivity and scars or “train track” marks
    • Nylon or Prolene (3-0 to 6-0)
suture selection size
Suture Selection - Size
  • Subcutaneous – 2-0 to 4-0 depending on need for strength, wound tension (e.g. larger suture over joints)
  • Neck, Scalp, Face (skin or surface): 5-0 or 6-0
  • Trunk, Extremities (skin or surface): 4-0
  • Palm, Sole, Back (skin or surface): 3-0
  • If child, use one grade smaller size (e.g. 5-0 instead of 4-0, etc.)
suture selection special cases
Suture Selection – Special Cases
  • Mouth, mucosa (vagina): use chromic or plain gut – will dissolve faster than Vicryl or Dexon
  • Eyelid, mouth edge, under breasts: use silk (if clean wound) as ends are softer and less irritating
  • Children (especially face – surface skin) use plain gut and tell parent to wash with H2O2 daily – no need to remove. Also useful if you think pt will not F/U for SR
local anesthesia
Local Anesthesia

Tip: don’t use epi for fingers, toes, penis (& nose?)

wound closure
Wound Closure
  • Undermine – reduce wound tension
  • Deep
  • Mattress
    • Horizontal
    • Vertical
  • Sub/Intra cuticular
wound closure undermine25
Wound Closure - Undermine
  • Tips
    • Keep ends on same side (“Don’t cross the streams” -Ghostbusters)
    • Cut close to the knot, but don’t cut the knot!!
wound closure deep 4
Wound Closure – Deep 4

Don\'t cross

the streams!!

wound closure mattress
Wound Closure - Mattress
  • Two types
    • Vertical
    • Horizontal
  • Both used to evert wound edges
  • V. Matt. useful to close deep space and skin w/ single stitch, and in uneven depth wounds
  • H. Matt. faster than simple interrupted as ½ the knot tying, useful in high tension wounds or as stay suture
  • Both may cause tissue strangulation
wound closure subcuticular
Wound Closure - Subcuticular
  • Used in cosmetically sensitive areas e.g. face
  • Running stitch that is easy to place and remove
  • Wound must be shallow or dead space eliminated with deep sutures
  • No tension on wound
  • Wound edges must be even in depth
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