Wound care and Suturing

Closure of minor wounds with sutures (1,2)

  • A thorough patient assessment is necessary before suturing. This includes:
      • History and exam
          • Mechanism of injury
          • Identification of possible contamination/foreign body
          • Assessment of neurovascular status and the wound extent.
      • Tetanus status
      • Identifying factors affecting healing
  • Indications
      • Typically, sutures are applied whenever a laceration extends through the dermis.
  • Contraindications:
      • There are wounds that are not appropriate for wound closure with sutures without further exploration in theatre.
      • This includes contaminated bites, infection, open joints and wounds that appropriate washout cannot be achieved.
  • Wound preparation
      • Irrigation of the wound
          • To ensure effective washout and patient comfort local anesthetic must be used to relieve the pain.
          • Isotonic saline or running tap water may be used.
          • A dilute betadine/water solution of 1:4 can be used as an antiseptic
  • There are multiple methods of wound closure, but the most commonly employed in our emergency department are sutures and wound strips (steri-strips)

Suturing (1)

  • Choosing what suture to use can be tricky, therefore, it is a good idea to ask a senior for advice. However, within the RD&E emergency department the available sutures are:
      • Dafilon (non-absorbale)
      • Novosyn (absorbable, 21 days hold and up to 70 days for absorption)
  • Suturing techniques
      • Percutaneous skin closure
          • Simple interrupted suture used for the closure of uncomplicated wounds.
      • Deep dermal closure
          • For deeper wounds. Absorbable material must be used for sutures that will be buried. Do not attempt without experience and senior advice
      • There are many others and if you are interested would be good to familiarise yourself with them.

References

1. Regula CG, Yag-Howard C. Suture Products and Techniques. Dermatologic Surg. 2015 Oct;41:S187–200. 2. DeLemos D. Closure of minor skin wounds with sutures - UpToDate [Internet]. [cited 2020 Feb 2]. Available from: https://www.uptodate.com/contents/closure-of-minor-skin-wounds-with-sutures
Image reference:Header - Licensed with Adobe Stock (2019)
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)