suturing and wound management
TRANSCRIPT
Wound management, local anaesthesia and suturing
Anisha Sukha FY1 doctor
Basics of wound healing
Local anaesthesia
Suturing materials
Practical example
Objectives
What is it?◦ Three phases: inflammatory, proliferative,
remodelling
Regeneration vs Repair
Wound closure◦ Primary vs secondary
Scarring
Wound healing
Mechanism of action Surface (e.g. Emla) Nerve Block Infiltration
◦ With or without adrenaline◦ Maximum doses◦ Unwanted effects◦ Contraindications
IV regional anaesthesia (Bier’s block)
Local Anaesthesia
Site Size Shape Surface Surroundings Edges Damage to underlying structures Nerve Damage Vascular damage Evidence of infection Evidence of retained material
Describing Wounds
What are you worried about?
Some examples
What type of ulcer?
Some examples
A 40 year old gentleman is brought into accident and emergency
At 09:00 he was washing his car when someone ran past and attacked him with a knife
He is brought in by ambulance He is haemodynamically stable and sat up
and talking to you in accident and emergency
What do you do?
Practical Example 1
A gentleman is 5 days post op following an emergency laparotomy for a perforated duodenal ulcer
The nurses request you see this gentleman because he is pyrexial
He is complaining of pain from the wound site but he is otherwise asymptomatic
What do you do?
Practical Example 2
Arterial ulcers Venous ulcers
(…see handout)
Diabetic ulcers
Other wounds to think about
Absorbable vs non-absorbable◦ Natural vs synthetic
Size
Needle Holder
Scissors
Forceps
Suturing materials
Questions?