Laceration Repar

restore function

repair tissue integrity

optimize cosmetic appearance

minimize risk of infection

Wound care goals?

primary intention

for simply, relatively clean wounds

variety of methods - suture, staples, commercial adhesive, steri-strips

secondary intention

letting the body heat it up by itself

for infected wounds, ulcerations, abscesses, abrasions, animal/human bites

allows skin to heal via granulation tissue, contraction & epithelialization

tertiary intention

delayed primary intention

for wounds too contaminated with soil, feces, saliva

irrigation and debridement and observe it for 5 days before closure

MOI, golden hour, anatomic locaiton, if worker’s compensation, tetanus status

hx questions for a patient

3

Within ___ hours after injury, bacteria growth at a level to cuase infection

12 hours

Acceptable golden hour for body/extremities?

24 hours

Acceptable golden hour for face and scalp?

indicated

If non-tetanus prone and last shot >10 years…

indicated

if tetanus prone and last shot >5 years….

any patient without tetanus vaccination hx or cannot differentiate td vs tdap

What patients should always get tetanus?

>6h old

>1 cm deep

stellate or avulsion configuration

devitalized tissue

contaminated

from a missile

puncture or crush

associated w/ burn

associated w/ frostbite

tetanus prone wounds?

nylon, porlene

What are the two non-absorbable sutures?

nylon

black, most commonly used, ties well, little tissue

prolene

blue, good for hairy areas, slippery

2-6 weeks

absorbable sutures are all biodegrade within _____ weeks

layered closures, lip/mouth lacs

absorbable sutures are best for what?

gut, chromic, synthetic

What are the 3 types of absorbable sutures?

gut

from cows/sheep submucosa, varied knot holding

chromic

gut with chromium salts, doubles life suture

synthetic

minimal tissue reaction, knot hold can be tough

polyglycolic acid

smaller

smaller or larger suture material as the number increases?

1-0 and 2-0

high stress areas requiring strong retention, i.e. deep fascia repair

3-0

areas requiring good retention, i.e. torso, extremities, joints, gaping wounds

4-0

Trunk or extremities where more strength of retention is needed, scalp

5-0

areas involving the face with more tension, ears, digits, palms, soles, scalp

6-0

areas requiring little or no retention, face, esp eyelid, vermillion border, cosmetic concerns

bigger

bigger bites, _____ needles

¼ circle

this needle has shallow curvature

used on easily accessible convex surfaces

typically used for ophthalmic and microsurgical procedures

3/8 circle

MOST COMMONLY USED NEEDLE

curvature makes it easy to manipulate in large and superficial wounds

difficult to use in deep cavities due to the large arc of manipulation needed

½ circle

this needle is to be used in confined locations

requires more pronation and supination of wrists

5/8 circle

this needle is ideal for deep, confined hole

often used by rotating the wrist with little to no lateral movement

simple, interrupted suture

most common outpatient/ED

simple running suture

most commonly used to close fascia

simple buried suture

layered closure

subcuticular running suture

best cosmetic outcome when done well

vertical mattress suture

decrease dead spaced and increase eversion

horizontal mattress suture

evenly distribute tension along edges

figure 8 suture

for vascular procedures and for hemostasis, used for fascia also, can be for quick suturing

halves

if simple laceration close the wounds in ______

all

instrument tie how many knots?

one

bring knots to two or one side?

pencil

when holding forceps how should they be held?

approximation without strangulation

equidistant placement

strategies

evert edges

Suturing principles?