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