Pro-Health Blog
By Clara | 19 July 2023 | 0 Comments

Wound Management and Suture Skills for the Medical Practitioners

Four Classification of Wounds

Based on the estimation of microbial contamination and risk of infection:

> Clean – surgical

> Clean-contaminated – usually surgical, such as appendicitis

> Contaminated – related to trauma

> Dirty and Infected contaminated – abscesses, FB contamination, surgical wounds that become infected.

Four Major Types of wounds

> Blunt: stab with a dull object

> Sharp: stab with a sharp object

> Foreign Bodies

> Bites

> Can further be defined as avulsion (partial, complete), abrasion, or deep

Wound healing

> Primary right away

> Secondary intent (inside out)

> Delayed Primary. Closed after some granulation of wound margins

Rules for wound closure

> Do not do a primary closure on dirty wounds

> Do not close wound on extremities or trunk over 12 hours

> Do not close wounds on face over 24 hours old

> Bites - should always avoid closure, if possible

> If mammal, placed on antibiotics

> Augmentin is the first line

Wound cleaning

> Normal Saline is the best

> Betadine is out

> Hibiclens is questionable

> Peroxide and alcohol products tend to do more tissue damage.

> Shaving is always bad

> Golden rule Clean and irrigate with pressure!

Local Anesthetic

> Inject through wound edges not directly into the skin

> Can buffer 10cc of local with 1 cc of NaHCO3

> Can warm in your pocket (the bottle)

Typical Topical Anesthetics

> All local are amides and are alkaline

> The effect depends on the amount of acid in the tissue.  PKA is decreased in the acid environment

> No cross-reaction or sensitivity in the group (most are allergic to the preservative methylparaben)

> Lidocaine allergy does not mean marcaine allergy

Suture Material


> Gut last 3-4 days

> Chromic gut 7-10 days

> Vicryl/Ethicon up to 14 days (least reaction)


> Nylon (Ethilon/Prolene) synthetic less reaction harder to tie

> Silk.  Biologic and braided, so increased risk of infection.

When to follow up

> Infection-prone wound

> 48-72 hours

> Any of the following signs/symptoms:

  • Fever
  • Redness
  • Wound site ascending lymphangitis
  • Systemic signs of illness
  • Nausea, Vomiting
  • Wound dehiscence

Suture Technique Guide

Simple Interrupted: 

> Do the passing technique, two loops around the needle holder, then grab the tail and do the knob.

> Indications: Single tooth extraction, third molar extraction flap, biopsies, implants, ...etc.

> Advantages: It is the most commonly used technique, preferred in urgent situations and it is easy to remove. Failure of one is inconsequential to the others.

> Disadvantages: It does not bring all surfaces into contact and is less supportive of the healing of flap margins.


Simple Running:

> Start it with a simple interrupted suture. Practice with Pro-Health's best suture pad.

> Then you cut the tail off and leave that last piece loose then you can do your loops.

> Indications: Bone graft, removal of mandibular tori, tuberosity reduction, and where esthetics are not important

> Advantages: It is very easy to produce and offers a more watertight closure

Disadvantages: If you cut one part of it, you lost all of it.

Subcuticular Running:

> The needle is introduced 10mm distal to one wound end and taken from alternating sides of the wound working towards the other wound apex.

> Indications: It is used to close the deep portion of surgical defects under moderate tension.

> Advantages: It is minimal epidermal puncture points allowing the suture to be left in place longer without suture-track scarring.

> Disadvantages: The risk of suture breakage and the formation of dead space beneath the skin surface.

Vertical Mattress: 

> The far, near technique.

> Indications: Where the wound edges tend to evert

> Advantages: Greater closure strength and better distribution of wound tension

> Disadvantages: Scar formation and the formation of edge necrosis.


Horizontal Mattress: 

> The strongest type of sutures, is very far away (8mm from the edge).

> Indications: Large distances between tissues, bone grafts and implants, and closure of extraction socket.

> Advantages: Good for hemostasis, less prominent scarring.

> Disadvantages: Leave a gap between flaps and it is difficult to remove.

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