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Wound Management and Suture Skills for the Medical Practitioners

By Clara July 19th, 2023 114 views
We provide different kinds of suture practice models so that medical students can learn wound types, wound management, and various suture techniques.

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

Absorbable

> Gut last 3-4 days

> Chromic gut 7-10 days

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

Non-Absorbable

> 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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