Clin Skills Exam 4 Advanced Suturing

What parts of the body are the vertical mattress sutures best used?

In the creases and areas of natural inversion (i.e. back of hand)

What suture technique consists of a 2nd "mini-suture"?

The vertical mattress

What is the purpose of the mini-suture used in the vertical mattress suture?

Ensures eversion of the skin edges

What is the purpose of a horizontal mattress suture?

To pull wound edges together over great distances

What suture technique can be used as an initial anchor to hold the two wound edges together?

The horizontal mattress

The horizontal mattress is a good hemostatic suture meaning what?

It can be used to stop profuse amounts of bleeding

What are the types of interrupted sutures?

-Simple

-Verticle Mattress

-Horizontal Mattress

-Subcuticular

What are the types of continous sutures?

-Running

-Running Locked

-Subcuticular

What suture type can be both interrupted and continuous?

Subcuticular

Facial lesions can be closed up to how long after the injury?

Up to 24h

T/F: Tissue of the face that seems ischemic will often flake off in 1 week.

False; Tissue of the face the seems ischemic often survives

What is the best choice for anestesia on the face?

Lidocaine with epi

(EXCEPT in the areas around the nose, ears, and flaps)

What is the proper suture choice for a facial laceration?

-Nylon for the skin

-Chromic/vicryl for the mucosal lacerations

What is the proper suture placement for a facial laceration?

1-2mm from the skin edges and 3mm apart.

Facial sutures are generally removed after how many days?

5-7

Where should you put the first suture for a lip laceration repair?

the first stitch at the border between the wet and dry surfaces

What is the best suture material to use for a lip laceration?

Absorbable 4-0

T/F: When sewing a lip laceration, it is acceptable to sew wet to dry and dry to wet mucousa?

FALSE; wet to wet. dry to dry.

How much knots should you tie for a lip laceration?

At least 4-5 knots

Where should the first suture be placed when suturing a partial-thickness lip laceration?

Just outside the vermilion border using 5-0/6-0 sutures

What types of suture material should be used for partial thickness lip lacerations and where?

5-0/6-0 sutures on outside vermilion and lip skin; 4-0/5-0 on lip mucosa

What does a full thickness lip laceration involve?

The outer skin, lip muscle, and mucosa

What should be repaired first in a full thickness lip laceration?

repair the inner aspect of the lip first absorbable 4-0 suture first

What should be used to repair the muscle in a full thickness lip laceration?

absorbable 3-0/4-0 figure of eight suture in the muscle

What are indications for repair of intraoral mucosal lacerations?

-Mucosal laceration that creates a flap that interferes with chewing

-Mucosal flap large enough to trap food

-Wounds longer than 2 cm

What is and where is the parotid duct located?

It is a duct that is a small, raised mound of mucosa inside the cheek across from the upper second molar

What suture would be used and where would it be placed for an intraoral mucosal laceration?

Absorbable 4-0 sutures would be placed 2-3 mm from the edge of the wound and include only the mucosa

In a full thickness cheek laceration involving the cheek skin, underlying subcutaneous tissue/muscle, and intraoral mucosa, what should be repaired first?

Intraoral mucosa

What should be used to repair the skin of a full thickness cheek laceration?

5-0 nylon sutures

What shot needs to be checked to be sure it is up to date after suturing?

Tetanus

What tongue laceration wounds would NOT require closure?

-Small lacerations <1-2cm

-Non-gaping wounds

What tongue laceration wounds would require closure?

-Large Lacerations (>1-2 cm)

-Large gaping wounds, esp with the tongue at rest

-Wounds requiring suturing for hemostasis

-Anterior split tongue

What type of suture and technique would you use for a tongue laceration?

3-0/5-0 in a figure of eight

T/F: In a full thickness nasal laceration, it is recommended to suture directly in the cartilage.

FALSE; don't do that

What size suture would you use for the outside and inside of the nose?

5-0

T/F: Shave those brows to get the suture in place.

False; don't shave somebody's eyebrows. EVER.

What is the primary goal of wound management with ear lacerations?

-Coverage of exposed cartilage

-Minimize hematoma

What does the acronym SCALP for scalp lacerations stand for?

S- Skin

C- subCutaneous tissue

A- epicranial Aponeurosis (muscle layer)

L- Loose CT

P-Periosteum

What must be closed with a full thickness scalp laceration?

The galea and the skin

What is the purpose of closing the galea with a scalp laceration?

It controls the bleeding and prevents the spread of the infection under the scalp

What size and type suture would you used to close the aponeurosis layer of the scalp?

3-0 or 4-0 Vicryl

When would a nerve block be indicated over local anesthesia for sutures?

-If it would not be effective in the area

-If edema from injection would distort landmarks or make palpation difficult

-When the area is very large

When are nerve blocks contraindicated?

-Infected tissue

-Septicemia

-Allergy to med

Where does the mental nerve run?

It exits the mandible just inferior to the second mandibular bicuspid approx 2.5 cm from the midline of the jaw

What gets anesthetized during a buccal nerve block?

the mucous membrane of the cheek and vestibule and a small patch of facial skin

Where does the infraorbital nerve run?

just beneath the notch at the infaorbital rim

When would you use an infraorbital nerve block?

Used to repair upper lip laceration and lacerations of the lower lateral nose and eye lid

Where is the lingual nerve located?

located on the lingual side of the second mandibular molar

What area is anesthetized by the lingual nerve block?

The anterior two thirds of the tongue

Where does he supraorbital nerve run?

Nerve exits at the supraorbital ridge