Wound care and Suturing
Closure of minor wounds with sutures (1,2)
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
- History and exam
- 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
- Irrigation of the wound
- 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)
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.
- Percutaneous skin closure
References
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)
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)
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)