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’iven a pt presenting with a laceration in an

office or urgent / emergent care setting and
standard supplies and equipment, treat the
wound appropriately.

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dentify the various types and sizes of suture

material.

Choose the proper instruments for suturing.

’iven a list of injectable anesthetic agents,

identify the different agents and correct dosages.

Determine whether a wound requires suturing.

Under supervision, anesthetize, clean, and close a

wound with sutures.

Recommend appropriate laceration care and

follow-up.
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Criteria
± Tensile strength
± ’ood knot security
± Workability in handling
± Low tissue reactivity
± Ability to resist bacterial infection

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£
 £ ÿ
DD
lose their tensile strength £
 £ ÿ
within 60 days.

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[£D
ÿ
Derived from the small
intestine of healthy
sheep.
Loses 50% of tensile
strength by 5-7 days.
Used on mucosal
surfaces.
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Treated with chromic
acid to delay tissue
absorption time.
50% tensile strength by
10-14 days.
Used in episiotomy
repairs.
 ] 


 
 
Ñraided
Low-memory
50% tensile strength = 25 days
Sites = subcutaneous closure skin

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onofilament

50% tensile strength = 30+ days

Sites = need for prolonged strength,

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Ñraided,synthetic polymer

50% tensile strength for 30 days

Usedÿ subcutaneous

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 ÿ ofall the non-
absorbable suture materials, monofilament
nylon is the most commonly used in surface
closures.

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[   

[ ÿ appears to be
stronger then nylon and has better overall wound
security.

£ÿ includes cotton, silk, braided nylon

and multifilament dacron. Ñefore the advent of
synthetic fibers, silk was the mainstay of wound
closure. t is the most workable and has excellent
knot security. Disadvantagesÿ high reactivity and
infection due to the absorption of body fluids by
the braided fibers.
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5-0 is small, and 2-0 is big

Theusual sizes = 3-0 or 4-0

Examplesÿ
± might use 5-0 on the face
± 2-0 on the plantar surface of a foot

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Wide variety with different company¶s

naming systems

2 basic configurations for curved needles

± Cuttingÿ cutting edge can cut through tough
tissue, such as skin
± Taperedÿ no cutting edge. For softer tissue
inside the body

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Tissue forceps
Dressing forceps

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ris scissors
are predominantly used to assist
in wound debridement and revision.

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Used for heavier tissue revision as necessary
for wound undermining.

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Clamping small blood vessels

Hemorrhage control

’rasping

Exposing

Exploring

Visualizing

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[ut a hypodermic needle on a small syringe

or use a hemostat to hold the needle

Ñend the tip of the needle back (sterile

technique)

’eneral principleÿ inimize trauma in

handling tissue

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Õ15 blade

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£
  
 





 
 
  


    

  

  



 


 


    
 




   


 

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Lidocaine (Xylocaine®)
± ost commonly used
± Rapid onset
± Strengthÿ 0.5%, 1.0%, & 2.0%
± aximum doseÿ

5 mg / kg

300 mg
± 1.0% lidocaine = 1 g lidocaine / 100 cc = 1,000mg/100cc
± 300 mg = 0.03 liter = 30 ml

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Lidocaine (Xylocaine®) with epinephrine

± Vasoconstriction
± Decreased bleeding
± [rolongs duration
± Strengthÿ 0.5% & 1.0%
± aximum individual doseÿ

7mg/kg, OR

500mg

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CAUTONSÿ due to its vasoconstriction

properties never use Lidocaine with epinephrine
onÿ
± Eyes
± Ears
± Nose
± Fingers
± Toes
± [enis
± Scrotum

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epivacaine (CARÑOCANE)ÿ
± Slower onset than Lidocaine
± Longer duration
± Strengthÿ 1%
± DOSEÿ maximum individual dose 5mg/kg

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ÑU[VACANE (ARCANE)ÿ
± Slow onset
± Long duration
± Strengthÿ 0.25%
± DOSEÿ maximum individual dose 3mg/kg

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25, 27, or 30-gauge

Aspirate
needle
nject agent into tissue

6 or 10 cc syringe SLOWLY

Check for allergies

Wait«

nsert the needle at the

After anesthesia has
inner wound edge taken effect, suturing
may begin

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" 

Wounds or lacerations with Wounds entering the

Nerve Thoracic
Tendon or abdominal cavities.
ajor vessel

Wounds or lacerations of the

Eye
Eyelids
Ñites
Severely contaminated
wounds.
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Time of incident

Size of wound

Depth of wound

Tendon / nerve involvement

Ñleeding at site

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Redness

Edema of the wound margins

nfection

Fever

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[uncture wounds

Animal bites

Tendon, verve, or vessel involvement

Wound more than 12 hours old

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[rimary closure (primary intention)

Secondary closure (secondary intention)

Tertiary closure (delayed primary closure)

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ost important step for reducing the risk of

wound infection.

Remove all contaminants and devitalized tissue

before wound closure.
± RR’ATE
± CUT OUT DEAD, FRA’ENTED TSSUE

f not, the risk of infection and of a cosmetically

poor scar are greatly increased

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[ersonnel [recautions

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Wound cleansing solution

Wound scrubbing

rrigation
± Take only the soft, flexible part from an 18
gauge V needle (angiocath)
± [ut angiocath tip on 20 cc or 50 cc syringe

Debridement

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[rinciples And Techniques

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! 

inimize trauma in skin handling

’entle apposition with slight eversion of

wound edges
± Visualize an Erlenmeyer flask

ake yourself comfortable

± Adjust the chair and the light

Change the laceration

± Debride crushed tissue

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± Ñite
± Throw
± [ercutaneous (deep) closure
± Dermal closure
± nterrupted closure
± Continuous closure (running sutures)

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Suture Techniques
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Apply the needle to the needle driver

± Clasp needle 1/2 to 2/3 back from tip

Rule of halvesÿ
± atches wound edges better; avoids dog ears
± Vary from rule when too much tension across
wound

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Rule of halves

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Rule of halves

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The needle enters the skin with a 1/4-inch

bite from the wound edge at 90 degrees
± Visualize Erlenmeyer flask
± Evert wound edges

Ñecause scars contract over time

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Release the needle from the needle driver, reach

into the wound and grasp the needle with the
needle driver. [ull 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.

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Rotate your wrist to follow the arc of the

needle.

[rincipleÿ minimize trauma to the skin, and

don¶t bend the needle. Follow the path of
least resistance.

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Release the needle and grasp the portion of the

needle protruding from the skin with the needle
driver. [ull 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.
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’rasp 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.
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Cutthe ends of the suture 1/4-inch from the

knot.

The
remaining sutures are inserted in the
same manner

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Always place the suture holder parallel to

the wound¶s 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.

Ñy always wrapping OVER and moving the

hand to the OTHER side = square knots!!
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’ood for everting wound edges

(neck, forehead creases, concave surfaces)

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’ood for closing wound edges under high tension,

And for hemostasis.

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After sutures placed, clean the site with

normal saline.

Apply a small amount of Ñacitracin and

cover with a sterile non-adherent dressing.

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Need for tetanus globulin and/or vaccine?

± Dirty (playground nail) vs clean (kitchen knife)
± mmunization history

Tellpt to return in one day for recheck, for

signs of infection or complications.

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Time frame for removing suturesÿ
Average time frame is 7-10 days
FACEÿ 4-5 days
ÑODY & SCAL[ÿ 7 days
SOLES, [ALS, ÑACK OR OVER JONTSÿ
10 days

Any suture with pus or signs of infections should

be removed immediately.
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1. Clean with hydrogen peroxide to remove
any crusting or dried blood
2. Using the tweezers, grasp the knot and
snip the suture below the knot, close to the
skin
3. [ull the suture line through the tissue- in
the direction that keeps the wound closed -
and place on a 4x4

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Once all sutures have been removed, count
the sutures
The number of sutures needs to match the
number indicated in the patient's health
record

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