Minimize trauma in skin handling

Gentle apposition with slight eversion of

wound edges
Visualize an Erlenmeyer flask
Make yourself comfortable
Adjust the chair and the light
Change the laceration
Debride crushed tissue
 Apply the needle to the needle driver
Clasp needle 1/2 to 2/3 back from tip
Rule of halves:
Matches wound edges better; avoids dog ears
Vary from rule when too much tension across
wound
Rule of halves
Rule of halves
 The needle enters the skin with a 1/4-inch bite
from the wound edge at 90 degrees
Visualize Erlenmeyer flask
Evert wound edges
Because scars contract over time
 Release the needle from the needle driver,
reach into the wound and grasp the needle
with the needle driver. Pull it free to give
enough suture material to enter the opposite
side of the wound.

Use the forceps and lightly grasp the skin edge

and arc the needle through the opposite edge
inside the wound edge taking equal bites.
 Rotate your wrist to follow the arc of the
needle.
Principle: minimize trauma to the skin, and
dont bend the needle. Follow the path of least
resistance.
 Release the needle and grasp the portion of the
needle protruding from the skin with the
needle driver. Pull the needle through the skin
until you have approximately 1 to 1/2-inch
suture strand protruding form the bites site.

Release the needle from the needle driver and

wrap the suture around the needle driver two
times.
 Grasp the end of the suture material with the
needle driver and pull the two lines across the
wound site in opposite direction (this is one
throw).

Do not position the knot directly over the

wound edge.

Repeat 3-4 throws to ensuring knot security.

On each throw reverse the order of wrap.
 Cut the ends of the suture 1/4-inch from the
knot.

The remaining sutures are inserted in the same

manner
 Always place the suture holder parallel to the
wounds direction.
Hold the longer side of the suture (with the
needle) and wrap OVER the suture holder.
With each tie, move your suture-holding hand
to the OTHER side.
By always wrapping OVER and moving the
hand to the OTHER side = square knots!!
Good for everting wound edges
(neck, forehead creases, concave surfaces)
Good for closing wound edges under high tension,
And for hemostasis.
 After sutures placed, clean the site with normal
saline.
Apply a small amount of Bacitracin and cover
with a sterile non-adherent dressing.