Complex Lac Repair (Skills)

Epidermis

Outer layer of the skin

Stratum Germinativum

The bottom layer of epidermis that constantly germinates new cells up

What structure is responsible for the cosmetic apperance of skin

Stratum Germinaituvm

Dermis

Layer of skin made of dense irregular CT below epidermis

Function of Dermis

Cushions the body from stress and strain

What is the found in the dermis

Blood vessels

Lymphatics

Nerves

Fat Cells

What gives dermis its tensile strength?

Collagen

Subcutaneous Tissue

Layer under the dermis made mainly of fat

Fascia

Layers of tissue that separate muscle from other structures (like skin)

Function of Fascia

Separate compartments of the body

Langer's Lines

The natural tension lines of the skin due to the orientation of collagen

When do we consider Langer’s Lines

Consider this when making surgical incisions

Consider when repairing a wound

What are the types of needle shapes

Straight

3/8 circle

½ circle

5/8 circle

What kind of points for needles exist

Taper (Pointed)

Blunt (Rounded)

Conventional Cutting (Flat Triangle)

Reverse Cutting (Full Triangle)

Use of a Circle Taper Needle

Close joint spaces

Use of a Small Half Circle needle

Close bowel

What are characteristics of suture material

Absorability

Synthetic / natural

Monofilament / Braided

What size suture is used for (ophthalmic)

10-0

What size suture is used for repairing small damaged nerves

8-0 and 9-0

What size suture is used for repairing small vessels and arteries

7-0

What size suture is used for delicate facial surgery

7-0

What size suture is used for vascular procedures

6-0

What size suture is used for larger vessel repair

4-0 and 5-0

What size suture is used for skin closure when there is a lot of tension on the tissue

2-0 and 3-0

What size suture is used for closing of the fascia layer in abdominal surgery

0 and 1

What size suture is used for for repair of tendons/ligaments/other high-tension structures

2

What are the principles of placing sutures

Approximation without strangulation

Equidistant placement (symmetry with width and depth)

Start with surgeon’s knot

Evert skin edges

Contraindication for Suturing

Grossly infected or contaminated wound

Indications for Simple Running Sutures

Straight, clean wounds with minimal tension

Lacerations on the face or other cosmetically sensitive areas

Skin flaps requiring approximation

Indications for Simple Buried Sutures

Closes wounds while keeping suture material hidden

close 5mm laparoscopic port sites

Indications for Vertical Mattress Sutures

wounds under tension

with minimal subcutaneous tissue

Benefits of Vertical Mattress Sutures

evert skin edges

Good strength of closure and good distribution of wound tension

Decreases “dead space”

Benfits to Horziontal Mattress

Good at spreading tension along a wound edge

Used to help evert skin edges

Indication for Horizontal Mattress

wounds under tension

Good for holding together fragile skin

Indication for Figure of Eight Suture

hemostasis

Locking stitch

Where are Running Subcuticular sutures place

Dermis

What material type is used for Running Subcuticular sutures

Absorbalbe

Indication for Running Subcuticular Suture

for straight, clean wounds with NO tension

Steps to Applying Dermabond

Clean and irrigate wound as usual (if needed)

Dry wound completely

Approximate the edges or have assistant to hold

Squeeze tube and roll on

Apply one layer, wait, apply another

Dressing will get glued to skin if application is not completely dry

Complications from Sutures

bleeding

malalignment of the wound edges

infection,

ischemia leading to necrosis,

non-healing wounds,

hypertrophic scar formation

When are facial sutures removed

5 days

When are scalp sutures removed

7-10 days

When are non-mobile extremity sutures removed

7 days

When are thick skin sutures removed

10-14 days

When are mobile body part sutures removed

14 to 21 days

Post-Op Care for Sutures

Cover with antibiotic ointment and dry sterile dressing for 24-48 hours

Okay to rinse with warm soapy water after 24-48 hours. Do Not Scrub!

Avoid: Prolonged soaking of stitches including swimming in chlorinated water and swimming in natural bodies of water