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Suturing Workshop Dr Samantha Murton MBChB Otago , FRNZCGP. Registrar Training September 1 st 2011 Auckland. Preparation. The 12 things you need Drawing Langers lines Margins – N aevi , benign appearing 1-2mm - BCC 3-5mm - SCC 5-10mm

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suturing workshop dr samantha murton mbchb otago frnzcgp

Suturing WorkshopDr Samantha MurtonMBChBOtago, FRNZCGP

Registrar Training

September 1st 2011

Auckland

preparation
Preparation
  • The 12 things you need
  • Drawing
  • Langers lines
  • Margins – Naevi, benign appearing 1-2mm

- BCC 3-5mm

- SCC 5-10mm

- Melanoma 5 – 20mm

anaesthesia
Anaesthesia
  • 1% lignocaine with 1:100,000 adrenaline, variety of others
  • No adrenaline on digits
  • 7 minutes to full effect of adrenaline
elliptical excision
Elliptical excision
  • The shape of the hull of a boat
  • Try to get a good amount of fat under lesion
suture material
Suture Material
  • Absorbable and non-absorbable
  • 3.0 to 6.0
  • How long to leave it in
    • Face 5 days
    • Neck/scalp 5-7 days
    • Trunk 7 – 10 days
    • Back and limbs 10 – 14 days
types of suturing styles
Types of Suturing Styles
  • Interrupted
  • Continuous
  • Mattress
  • Subcuticular
subcuticular
Subcuticular
  • Use absorbable suture
  • Evert the skin
deep sutures
Deep Sutures
  • Most wounds could do with them
  • Helps with haemostasis
  • Takes tension off skin
  • Absorbable suture
  • Bury the knot
dressing
Dressing
  • Steristrips along wound take the tension off
  • Some may require pressure dressing for a couple of days
  • Skin adhesive may help with dressings to stick
  • Micropore
  • Suture guide/care of wound guide
rhomboid flap
Rhomboid Flap
  • Good on back or places where adequate tissue to move and big lesion to excise
  • Make sure well marked out
  • No tension on wound
  • Close flap wound first then defect
  • Continuous suture