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SUTURING

Chandler Church B.S., MAT

Dacie Sanders B.S., MAT

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TABLE OF

CONTENTS

01.

02.

INDICATIONS & CONTRAINDICATIONS

MEDICATIONS

03.

TYPES OF SUTURE & SIZING

04.

SUTURING METHODS

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INDICATIONS

Wounds up to 12 hours old

    • Prefer <6 hours

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Wounds deeper than the dermis or that cross skin tenson lines

    • want to minimize scarring

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CONTRAINDICATIONS

    • Wounds >12 hours old
    • Puncture wounds
    • Contaminated wounds that are not able to be irrigated
    • Known infection

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REFER

    • Lip vermillion border, through the lip, eyelid, or ears.
    • Significant tissue loss, complex wounds, NV compromise, or fracture.

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ANALGESICS

Lidocaine (1 or 2%)

    • Duration: 30 minutes – 1 hour
    • Max Dose: 30 mL (1%), 15 mL (2%)

Lidocaine w/ epinephrine (1 or 2%)

    • Duration: 2-6 hours
    • Max Dose: 50 mL (1%), 25 mL (2%)

Bupivacaine (0.25 or 0.5%)

    • Duration: 2-4 hours
    • Max Dose: 70 mL (0.25%), 35 mL (0.5%)

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Bupivacaine w/ epinephrine (0.25 or 0.5%)

    • Duration: 3-7 hours
    • Max Dose: 90 mL (0.25%), 45 mL (0.5%)

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SIZE

TYPE

    • Face (nose, vermillion border, eyelid) 6-0
    • Face (forehead, cheek, chin) & fingers/toes 5 or 6-0
    • Scalp, trunk, extremities, palm/sole 4 or 5-0
    • Trunk, extremities (wounds under tension) 3 or 4-0
    • Tongue 3 or 4-0

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    • Nylon (ethilon) – nonabsorbable, any site
    • Polypropylene (Prolene) – nonabsorbable, any site
    • Fast-absorbing gut – absorbable, used for face
    • Polyglactin (Vicryl Rapide) – absorbable, scalp, lacerations under cast/splint, or oral mucosa/tongue
    • Chromic gut – absorbable, scalp, nailbed, lacerations under cast/splint, or oral mucosa/tongue
    • Polyglactin (Vicryl) – absorbable, any site
    • Poliglecaprone (Monocryl) – absorbable, any site

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SUTURE METHODS

02.

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Simple Interupted

Horizontal Mattress

    • Commonly used
    • Good for small wounds
    • Distributes tension along the length of the laceration

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Hidden “X” Suture

Running Suture

    • Commonly used during surgery for portal closures
    • Good for small wounds
    • Fast method for closing a long, straight wound.
    • Low risk of infection

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PROTOCOL

AFTERCARE

    • Informed Consent
    • Gather materials
    • Clean & irrigate wound
    • Anesthetize wound
    • Begin suturing

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    • Dress the wound
      • sterile gauze, adhesive bandage, tegaderm
    • Bathing
      • keep dry for 24 hours
      • avoid prolonged submersion
    • Suture removal timeframe
      • Face, eyelids, neck - 5 days
      • Scalp - 7 to 10 days
      • Trunk & UE - 7 days
      • Lower Ex - 8 to 10 days
      • Digits, palms, soles - 10 to 14 days

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THANK YOU

Do you have any questions?