basic laceration repair techniques

1. Basic Laceration Repair Techniques Saleh Almanea PEM Physician

3. Needle holder Use Grasp the needle in an area 1/3 � � of the distance from the swaged end to the point. Swaged area is the weakest part Do not grasp the needle too tightly, single click is recommended. Needle holder size depend on the needle size.

4. Definitions Bite : the amount of tissue taken when placing the suture needle in the skin or facia. Throw : each suture knot consists of a series of throws. Percutaneous (skin) closure : Nonabsorbable, Knot tied on the surface. Dermal (deep) closure :absorbable, in the subcutaneous and dermis, knot buried in the wound. Interrupted closure : single suture, tied separately, either deep or percutaneous. Continuous closure ( running suture) : several bite full lenth of the wound, knots at thwe beginning and end of the wound.

5. Basic knot tying techniques The most common is the surgeon�s knot Double first throw offers better knot security and less slipping of the suture The wound edges will remain opposed while second and subsequent single throws are accomplished. hand tie with hemostat to control bleeding.

6. Basic knot tying techniques

9. Layer matching Deep fascia, superficial fascia & dermis. Failure to oppose layers can cause improper healing and large scar.

10. Wound Edge Eversion Very important Normal tendency of the scar to contract

11. Wound Edge Eversion Techniques

12. Wound Edge Eversion Techniques

16. Wound Tension Its very important to minimize tension to preserve capillary blood flow to the wound edge With increase in tension may lead to Ischemia and necrosis and result in irregular unaccepted scar. WHEN TYING KNOTS.THE FIRST THROW IS CRUCIAL.AS THE WOUND EDGES ARE BROUGHT TOGETHER.THEY ARE ALLOWED TO JUST BARELY TOUCH. IF FIRST THROW TOO TIGHT, PROMOTE ISCHEMIA. Edema to the suture line worse the tension.

17. Techniques For Reducing Wound Tension Deep closures. Infection if many. Greater healing and scar.

18. Techniques for reducing wound tensionwound undermining Proper tissue plane betw superficial fascia(subcut tiss.) and deep fascia Scalp Forehead Lower leg esp over the tibi where the skin under tension ?bacterial infection. ? Dead space. Sutures act as Foreign bodies

19. Techniques for reducing wound tension Additional suture placement

20. Dead space

21. Closure Sequence and Style

22. SUTURING Absorbable sutures, such as (Vicryl), (Dexon), (Monocryl), are used to close deep, multiple-layer lacerations. Although these sutures absorb at varying rates, they all usually absorb within four to eight weeks. Nylon, monofilament nonabsorbable sutures (e.g., polypropylene [Prolene]) must eventually be removed.

23. SUTURING use the finest suture possible, depending on skin thickness and wound tension. In general, a 3-0 or 4-0 suture is appropriate on the trunk, 4-0 or 5-0 on the extremities and scalp, and 5-0 or 6-0 on the face. Bluecolored sutures may be beneficial for scalp lacerations in appropriate populations to differentiate the suture from the hair. absorbable 3-0 or 4-0 suture for Mucosal lacerations (e.g., mouth, tongue, genitalia)

25. Tissue Adhesives such as 2-octylcyanoacrylate (Dermabond) Tissue adhesives are contraindicated in patients at higher risk of poor healing (e.g., those who are immunosuppressed or have diabetes), and should not be used for contaminated, complex, or jagged lacerations. avoided on mucosal surfaces and areas that maintain moisture, such as the groin or axillae

26. Tissue Adhesives The wound edges are approximated using gloved fingers, then the adhesive is applied in a thin layer over the wound with a 5-mm overlap on each side. Three to four layers are applied with 30 seconds between applications. Full tensile strength is achieved after 2.5 minutes. Antibiotic and white petrolatum ointments can remove tissue adhesive; therefore, patients must be instructed to avoid using them on the repaired wound.

27. Dermabond

28. hair apposition technique

29. Other Techniques Stapler strips (e.g., Steri-strips)

30. THANKS