1. Suturing Tanith D. Turner-Lumb Clinical Education Manager BRI

2. Wound Closure Before the repair of wounds or lacerations is initiated, a thorough evaluation of the patient must be completed. Wound characteristics, anatomic site, and underlying conditions that affect the management of every wound. Before the repair of wounds or lacerations is initiated, a thorough evaluation of the patient must be completed. Wound characteristics, anatomic site, and underlying conditions that affect the management of every wound.

3. Wound Closure There are 3 types of wound closure: Primary (Primary Intention) Primary (Primary Intention) Secondary (Secondary intention) Secondary (Secondary intention) Tertiary (Delayed Primary Closure) Tertiary (Delayed Primary Closure)

4. Contraindications for Suturing Wounds Reddening/Oedema of wound margins Reddening/Oedema of wound margins Discharge or Pus Discharge or Pus Fever or Toxeamia Fever or Toxeamia Puncture Wound/Animal Bite Puncture Wound/Animal Bite Tendon/Nerve/Vessel Involvement Tendon/Nerve/Vessel Involvement Wounds ‘older’ than 12hours (after injury) Wounds ‘older’ than 12hours (after injury)

5. Sutures Absorbable Surgical Gut DexonChromic Non Absorbable NylonProleneBraided

6. Suture size Sutures are measured by width or diameter. 6-0 (smallest) 6-0 (smallest) 5-0 5-0 4-0 4-0 3-0 3-0 1-0 and 2-0 1-0 and 2-0

7. Needles Needle length is in millimetres Needle length is in millimetres Needle shapes are generally classified by the degree of curvature of the body. Needle shapes are generally classified by the degree of curvature of the body. Taper Point Taper Point Blunt Point Blunt Point Conventional Cutting Conventional Cutting Reverse Cutting Reverse Cutting

8. Technique It is important that the wound is closed in equal ‘bites’ both horizontally and vertically. It is important that the wound is closed in equal ‘bites’ both horizontally and vertically. The wound edges should be slightly everted. The wound edges should be slightly everted.

9. Technique Hold the needle (with needle holder/driver) a quarter distance from the blunt end. Hold the needle (with needle holder/driver) a quarter distance from the blunt end. The needle should enter the skin with a ¼ inch bite from wound edge at a 90 degree angle. The needle should enter the skin with a ¼ inch bite from wound edge at a 90 degree angle.

10. Technique Release needle, reach into wound, grasp needle and pull free. (one side of the wound is ‘done’ at a time) Release needle, reach into wound, grasp needle and pull free. (one side of the wound is ‘done’ at a time) Using forceps, lightly grasp the skin edge and arc needle through opposite edge, inside the wound. Using forceps, lightly grasp the skin edge and arc needle through opposite edge, inside the wound. Release the needle, and grasp the protruding needle from the skin and pull through. (leave approx ½ to 1 inch protruding from bite sides) Release the needle, and grasp the protruding needle from the skin and pull through. (leave approx ½ to 1 inch protruding from bite sides)

11. Technique Release needle and wrap suture around the needle holder 2 times. Release needle and wrap suture around the needle holder 2 times. Grasp the ends of the suture material and pull the 2 lines across wound site in opposite directions. (this is called ‘a throw’) Grasp the ends of the suture material and pull the 2 lines across wound site in opposite directions. (this is called ‘a throw’) Repeat 3-4 times, but on each throw reverse the order of the wrap. Repeat 3-4 times, but on each throw reverse the order of the wrap. Cut ends of suture ¼ inch from knot Cut ends of suture ¼ inch from knot Do not position knot directly over the wound edge. Do not position knot directly over the wound edge.

12. Technique

13. Suture Removal Times will vary according to the location and depth of the wound. However, the average time frame is 7-10 days after application Times will vary according to the location and depth of the wound. However, the average time frame is 7-10 days after application Face Face Body and Scalp Body and Scalp Soles, Palms, Back or Other Joints Soles, Palms, Back or Other Joints Any suture with pus or signs of infections should be removed immediately. Any suture with pus or signs of infections should be removed immediately.

14. Suture Removal Using the tweezers, grasp the knot and snip the suture below the knot with the scissors as close as possible to the skin. Using the tweezers, grasp the knot and snip the suture below the knot with the scissors as close as possible to the skin. Pull the suture line through the tissue Pull the suture line through the tissue Once all sutures have been removed count the sutures. 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. The number of sutures needs to match the number indicated in the patient's health record.

15. Any Questions