Absorbable sutures. For stomach, colon, bladder.
Redness, pain, edema, exudate, fever, and chills.
<p>Absorbable sutures. For stomach, colon, bladder.</p>
Ensure the package is sufficiently open and the item can be grasped without risking the sterile field.
A simple straight laceration.
<p>Absorbable and Non-absorbable. Monofilament vs Multifilament. </p>
They are commonly used for the sternum, bone, and tendon.
A wound where lacerations radiate out from the central defect, resulting in a round, oval, crescent, star, or stellate appearance.
A 'soft tissue' X-ray, which is slightly underdeveloped.
Universal precautions and sterile/clean technique.
Stainless steel sutures are strong.
They resist infection.
A handheld needle that is long to obtain wide bites and is ideal for skin.
The draped patient and anyone scrubbed in or the field set up at bedside.
<p>It releases tension on the final closure and reduces dead space. </p>
A minimum of two individuals.
<p>You can put your thumb and fourth finger in the rings or hold it in your palm ('palming') with your index finger stabilizing it. </p>
Dog/cat/human bites, exposed joints or tendons, open fractures.
Antibiotic treatment or the wound may need to be closed loosely or left open.
PA (Posteroanterior), Lat (Lateral), Oblique, and Tangential views.
An appropriate anesthetic agent based on the location and size of the foreign body.
Patients are usually very accurate regarding the location of the foreign body.
Gauze.
If indicated by the assessment.
Information on the procedure, aftercare, and signs of complications.
Because the palm of the hand is very prone to infection.
Braided or monofilament.
Polyester sutures are stronger than silk sutures.
Minimal tension and minimal dead space.
To avoid 'dog earing'.
<p>Release the needle, PRONATE hand, grasp needle proximal to tip, and then supinate through.</p>
Yes, but having an assistant is optimal.
Exercise caution.
Steri-Strips.
<p>By the number of zeros. Increases in number as diameter of suture decreases.</p><p>Smaller size = less tensile strength. </p><p>3 > 2 > 1 > 0 > 2-0 > 3-0</p>
<p>Cut with the tip, not beyond with the screw facing up at a 45 degree angle to suture. </p>
Neosporin, adaptic, 4x4’s, kling, tape, ace.
Approximate, don’t strangulate.
To ensure all fragments of the foreign body are identified.
A half-buried horizontal mattress suture is recommended for corner wounds in avulsion lacerations.
To divide the dermis from the subcutaneous layer.
Immobilization.
Remove and replace it with a sterile item.
<p>A flap of skin that is torn loose and hanging or completely removed that can bleed heavily. </p>
Heal by secondary intention.
<p>It sloughs off in 5-10 days no follow up. </p>
<p>Infection, bleeding, trauma to local vital structures, scarring, and inability to remove or completely remove a foreign body with resultant further surgery with needle localization, fluroscopy, ect. </p>
They are minimally reactive.
<p>Dog bite, cat bite (pasturella), and stepping on a nail. Do NOT close these. </p>
An avulsion laceration is a type of wound where a portion of tissue is forcibly detached from its normal point of insertion.
Bisect each distance until closed, known as the rule of halves.
The edges should be aligned and everted.
Following the lines of Langer helps in minimizing scarring and improving cosmetic outcomes.
To prevent and identify infection.
<p>2/3 to 3/4 way down the needle using the dominant hand with the forcep in the other. </p>
Packaged to allow an unsterile person to open and pass them into a sterile field without contamination.
<p>Non-absorbable sutures. For skin, fascia, tendon. </p>
Wound eversion is important because it helps to minimize scar formation and ensures better healing by reducing tension on the wound edges.
A type of avulsion wound in which an extensive section of skin is completely torn off the underlying tissue, severing its blood supply.
Forceps.
<p>Straight cuts with edges that can be approximated, low tension wounds, dry surface wounds. </p>
<p>A plastic or trauma surgeon because can be devestating and complex and may require multiple types of repair. </p>
<p>Gentle handling of tissues and grasp the dermis if possible with toothed forceps. Use minimum required pressure. </p>
Benzoin can be used to create a sticky surface for the strips to stick to.
The underlying structure.
<p>Small inert monofilament (Nylon, Prolene®), Subcuticular suture (vicryl), steri-strips, dermabond.</p>
<p>Irrigate the wound and debride.</p>
Easy to perform, good healing/circulation, easy to remove, minimal trauma, allows for some minimal drainage.
<p>Betadine (cannot use if allergic to shellfish) and Chlorhexidine.</p>
Unless there is a high risk of infection.
It may have a 'slight shadow'.
To work within the sterile field.
<p>They are quick and painless to apply plus have an antimicrobial effect. </p>
<p>Grossly contaminated wounds (sticks, dirt), most bite wounds, gunshot or fragmentation wounds, wounds > 8 hours old. </p>
<p>Undermining is used to separate tissue layers, Dissection, cutting. </p>
Paint over the wound edge, holding the skin together, and allow 60 seconds of drying time.
<p>Rapid placement and approximation and provides a good seal. </p>
An exit wound from a gunshot wound (GSW).
<p>It is ideal for skin suturing, central line kits, and triangular cutting needle. </p>
Repairing 'dog ear'.
Partial, loose closure.
Skin closure with mild degradation.
Skin closure and tendon repair, and they hold knots better.
<p>Linear, Avulsion (flap or degloving), stellate, puncture, crush, abrasion. </p>
<p>Leaving dead space can lead to infection.</p>
Temporary approximation of wound edges.
PDS® and Maxon®.
They can be used for simple wound closure along with Dermabond and after sutures are removed to help with closure and healing.
You should ask about an iodine allergy.
Good history and physical examination, including orientation and size of the foreign body.
Approximate, don’t strangulate.
To accurately locate and safely remove the foreign body.
Absorbable sutures are not removed, while non-absorbable sutures are removed.
<p>A method by which contamination with microorganisms is minimized. Sterile is defined as germless and free from all living or viable microorganisms. </p>
<p>Lacerations that run parallel to the lines of Langer should be re-approximated. Langer lines correspond to the natural orientation of collagen fibers in the dermis, and are generally parallel to the orientation of the underlying muscle fibers. Incisions made parallel to Langer lines may heal better and produce less scarring than those that cut across. </p>
<p>Curved or straight, blunt or sharp. </p>
Cosmetic skin wounds and abdominal fascia closure.
To use unsterile hands to pass supplies into the sterile field.
The width of each stitch equals the distance between sutures.
Leave tails on monofilament knots and on sutures requiring removal.
Position so dripping occurs away from the eye.
<p>Breakage disrupts the entire suture line, it can transmit infection along the entire length of the suture. </p>
Better tensile strength and less tissue reaction.
Fascia more commonly than skin.
The suture is placed 'across, over, and back.'
6-0 Nylon.
6-0 plain gut or vicryl.
In a line parallel to the dermis, just under the epidermis.
Lay it flat and realign it to its normal position for repair.
They provide the best cosmetic result.
Cut buried skin knots short.
Under and over the area of the wound.
Silk suture is commonly used for eyelid and intraoral lacerations.
Conscious sedation.
They require removal.
Use a circular motion from inside out.
<p>Several strands twisted or braided together. It provides more tensile strength, but has more of a FB reaction. Higher infectious risk but better knot security. Rarely placed extenally, usually INTERNAL. </p>
Wounds under tension.
Scalp, trunk, and extremity lacerations.
<p>Vertical mattress, horizontal mattress, deep dermal. </p>
Adequate tension helps in proper wound closure and healing.
It is an everting suture technique.
<p>A suture pattern that uses several separate strands. It is secure and wound integrity is not dependent upon a single suture. </p>
Pull up on the knot.
The ventral tongue.
Vicryl or Monocryl.
A corner stitch is used to close wounds that form a corner or an angle, such as those found on the face or joints.
In the deep muscle layers of a laceration.
To provide an environment for the patient that promotes healing, prevents infection, and minimizes the length of recovery time.
Continuous Running
Added strength, especially in fascia and thick skin.
Vicryl® and Dexon®.
They are hydrolyzed in tissue fluids.
Absorbable sutures.
Wound eversion is when the wound is elevated to minimize scar depression as it heals.
Bowel, vascular, and skin.
In tissue that heals slowly or never regains its strength.
<p>An instrument tie is a technique used to secure sutures using surgical instruments rather than by hand. Loop the suture twice around the needle drive, then only once after. </p>
<p>NS should be repeatedly squirted into the wound site in short bursts to dislodged remaining particulate matter.</p>
Operating room (OR), office procedures, and bedside procedures.
Do not let glue seep into the wound.
<p>Silk is a non-absorbable suture that is braided that can remain undetectable in tissue after 2 years. </p>
21 days.
Remove every other suture.
Stomach, colon, and bladder.
2 days.
Dissection.
Antibiotic ointment can soften the bond.
Crush the ampule and invert it, soaking a cotton-tipped applicator.
Iris scissors or a #11 blade.
Make sure you have the entire suture out and don't just cut the knot off.
Tetanus.
Gaping wounds and wounds with high tension.
Longer than usual to minimize the risk of water contamination and infection.
A subcuticular suture is a type of suture placed just under the skin, running parallel to the wound edges.
Linear lacerations.
Steri-Strips.
<p>With the thumb and 4th (ring) finger with the screw of scissors facing up and at 45 degree angle and the index finger supports the shaft of the scissors. Insert the blunt tipped scissors into wound, spread to divide tissue planes, and blunt outer edges separate tissues. </p>
Baseball stitch.
If they are less than half an inch.
Like a pencil in the non-dominant hand.
8-10 days
Always check for full thickness.
<p>Scarring is increased, removal is more painful than sutures, and cannot do if you plan to use CT or other imaging.</p>
It is less cosmetic.
Yes, absorbable sutures can be used for some skin repairs.
Oral pain medications.
Daily with soap and water, followed by good drying and reapplication of dressing.
Prolonged soaking.
12-14 days
They are not digested or hydrolyzed.
Debakey forceps, Adson/toothed forceps.
Implanted defibrillators, pacemakers, pumps, and nerve stimulators.
Absorbable suture.
No, not all foreign bodies need to be removed.
Areas of high motion, mucosal surfaces, dirty wounds, bites, irregular edges, wounds >10cm, and punctures.
4-0, 5-0
A suture technique using a single continuous strand.
Blades, Scissors, Forceps, Needle holders/drivers.
<p>Everting and providing precise edge approximation with great wound strength.</p>
24-48 hours.
2-3 days
X-ray or ultrasound (US).
2-0, 3-0
In the deep layers of an incision.
Use the finest suture size appropriate for the natural strength of the tissue.
Absorbable suture.
Because they cosmetically look better.
Far-Far/Near-Near.
To prevent the accumulation of fluids and reduce the risk of infection.
8-10 days
<p>• Infection</p><p>• Scarring – keloid</p><p>• Loss of function and structure</p><p>• Loss of a cosmetic appearance</p><p>• Wound dehiscence</p><p>• Tetanus</p>
Wounds in areas with hair or skin folds, axillae, and perineum.
4-0, 5-0
<p>90 degrees / perpendicular into skin. Supinate through with the ring finger pushing down and the thumb base pushing up. Drivers are in line with the forearm. </p>
<p>• Contaminated wounds</p><p>• Wounds older than 8-12 hours</p><p>• Facial, neck or scalp lacerations older than 24 hours</p><p>• Presence of foreign bodies</p><p>• Wounds involving tendons, nerves, arteries</p><p>• Needs repaired by specialist</p>
For tissue that heals rapidly.
<p>Irrigate the wound. May need reapproximation of wound edges if excised. Sterile bandage. Good pt instructions. FU in 1-2 days, then usually 5-7 days. Antibiotics (topical) as necessary. Tetanus eval / prophylaxis if needed. Referral if needed. Good hx and exam on FU. </p>
<p>A suture made of a single strand. Provide less tensile strength and have less FB reaction. Ties down smoothly. Has a lower risk risk of infection, but less knot security / requires more throws. </p>
<p>Broad and strong jaws with smooth surfaces to help prevent needle slippage. They are regular, heavy, or fine-tipped. Should be held in the dominant hand. </p>
<p>Common materials include vicryl, monocryl, coated vicryl, PDS, plain gut, chromic gut. </p>
8-12 days
<p>A type of suture material that is not broken down by the body and remains in place until it is removed. Usually Nylon, Polyester, Polyprolene, Silk.</p>
The first step in wound preparation is cleansing the wound to remove debris and reduce the risk of infection.
3-0, 4-0
6-8 days
8-10 days
5-0, 6-0
4-5 days
4-5 days
<p>If needed, based on the complexity or risk of the removal procedure OR if FB removal req X-ray / US. </p>
12-14 days
<p>20-30 or 60 mL syringe with 18 G angiocatheter, scalpel or scissors, gloves, and goggles, irrigation. </p>
<p>Irrigation, sterile metal probe, grasp with Adson pickup/forceps with teeth and remove, punch biopsy tool removal, excisional removal</p>
<p>Reactive material – wood, vegetative materials</p><p>• Contaminated material</p><p>• Clothing should always be considered contaminated</p><p>• Most foreign bodies in the foot</p><p>• Impingement on Neurovascular structures</p><p>• Impairment of function</p><p>• Easy to remove and without risk of complication</p>
<p>Splinter forceps have fine pointed ends with NO teeth. </p>
<p>Cleanse and anesthetize the area if needed. Do not pinch or squeeze area. Splinter forceps / tweezers can be used, or an 18 G needle or 11 blade. </p>
<p>Sterile 0.9% normal saline. Do NOT use H2O2 on open area. Use a syringe and needle, bulb irrigation, splash guard if available. </p>
<p>Prep the area and lightly probe the wound with a sterile instrument until gentle contact is made with the FB. The try to remove with Adson’s forceps. (DO NOT blindly grasp anything unless you are sure it is the FB). If not removed with forceps, use punch bx tool for removal or do a surgical excisional removal. </p>
<p>• All items used within sterile field must be sterile</p><p>• A sterile barrier that has been permeated must be considered contaminated</p><p>• The edges of a sterile container are considered</p><p>contaminated once the package is opened</p><p>• Tables are sterile at table level only</p><p>• Sterile persons and items touch only sterile areas</p><p>• Unsterile persons and items touch only unsterile</p><p>areas</p><p>• All items and areas of doubtful sterility are considered contaminated</p><p>• Movement within or around a sterile field must not contaminate the field</p>
<p>• Hemostasis</p><p>• Supporting and strengthening wounds until</p><p>healing increases their tensile strength</p><p>• Decrease healing time</p><p>• Reduce infection</p><p>• Improve cosmetic appearance</p><p>• Decrease scar tissue likely to form</p>
It is a suture technique that provides good wound edge approximation and is useful in areas under tension.
A one hand tie is performed using only one hand, while a two hand tie is performed using both hands.
Ties, one hand tie, two hand tie, instrument tie, simple interrupted, running, subcutaneous/subcuticular, vertical mattress, horizontal mattress.
It is a continuous suture technique where the suture is run in a continuous manner without tying off each stitch separately.
It is a suture technique that provides good wound edge eversion and is useful in areas under tension.
It is a method of tying sutures using surgical instruments rather than hands.
It is a suture technique used to close a wound just below the skin surface.
It is a suture technique where each stitch is tied off before starting the next one.
By tissue enzymes, causing tissue reaction.
14 days.
Sheep intestine.
7 days.
