emergency wound care and suturing louis morales, jr., md

Emergency Wound CareAnd Suturing

Louis Morales, Jr., MD

Objectives

• Care of wounds• Methods in optimizing final wound

closure• Suture techniques, knot tying

Why Learn to Suture

Faced With a Wound

• Assess extent of wound

• Local anesthetic• Cleanse wound• Decide what mode

of closure would be feasible Knife laceration

Treating Wounds

• Assess wound – dirty vs clean• Dirty – falling into manure, human bite, etc.• Debridement – remove debris• Soap and water okay but rinse well• Wound cleansing – Betadine or Prepodyne• Hydrogen Peroxide initially but not long

term

Modes of Wound Closure

• Sutures• Steri-Strips (Butterfly tape)• Skin Stapler• Skin adhesive (glue)

Suture Wound Closure

• Necessary Instruments – forceps, needle holder, hemostat, sutures)

• Local anesthetic – Lidocaine with epi • Gauze dressings, Ace bandage, etc.• Meds: Narcotics, antibiotics, epinephrine,

ointment

Minor Lacerations

• Debride if necessary• Trim edges of skin as needed• If contaminated then irrigate

under pressure • If deep, then place subdermal

stitches• Approximate skin margins

using smallest stitch possible

Bites

• Debride as necessary• Interrupted permanent stitches as infection

is a possibility• Antibiotics for Cat bites and Human bites• If seen late, may have to heal by secondary

intention

Post Repair Care

• Stitches should be removed from skin within 5-10 days depending on area

• Use immobilization or Steri-Strips for 3 months

• If Skin staples used must remove sooner

Principles of Wound Closure

• Gently handle tissues• Take small tissue “bites”• Lightly approximate tissues• Use smallest suture possible

Using the Instruments

• Hold the forceps in your nondominant hand• Hold the scissors in your thumb and ring finger,

stabilize the tip with your index finger

Using the Instruments

• Hold the needle driver with your thumb and ring finger

• Use your index finger to stabilize the needle driver tip

Using the Instruments

Hold the scalpel like a pencil or paint brush

Using the Instruments

Hold the needle one-third to one-half of the distance from the end to the point

Place needle holder on flatpart of needle

Suture Workshop – Pig Flanks

Simple Suture

Remember thatforceps shouldnot strangulate tissues

Simple Suture

Deep Buried Suture

‘Baseball’ Stitch

Skin Adhesives

• Dermabond – Quick drying medical adhesive

• Can use cyanoacrylate (crazy glue)

• Apply 2 light coats a few minutes apart

• Avoid contact with the eyes

Surgical Tape

It is important to keep Steri-Strips on for at least3 months to decrease stretching of scar

When do you Remove Sutures?

• Rule of thumb:

Face: 3-4 daysScalp: 5 daysTrunk: 7 daysArm or leg: 7-10 daysHand or foot 10-14 days

Summary – What’s in Your Pack

• Instruments for suturing – basic – hemostat, needle holder, forceps with teeth, scissors

• Sutures • Local anesthetic – injection, spray, gel• Steri-strips• Skin glue – cyanoacrylate