1. Pain Control
2. Proper Irrigation of a wound
3. Deciding What type of Suture to use
   1. Do Not Get lost here in general use the following

                                         i.    External superficial use Nylon (non Absorbable)

                                        ii.    Subcuticular or Deep use Vicryl or Dexon

                                      iii.    Face Gut or fine Nylon (we like nylon bc pt returns for wound check)

As time goes on and you get more experience suturing we sometimes consider other factors like suture strength, rate of decay, and type of material for certain wounds BUT IN GENERAL USE ABOVE GUIDE. This is just food for thought.

Absorbable
Gut	Plain	Mammalian collagen	7 to 10 days
Gut	Chromic	Mammalian collagen	21 to 28 days
Polyglycolic acid (Dexon * )	Mono	Synthetic polymer	20% in 15 days 5% in 28days
Polydioxanone (PDS)	Mono	Polyester polymer	70% in 14 days 50% in 28 days
Polyglactic acid (Vicryl)	Braided	Coated polymer	60% in 14 days 30% in 21 days
Polyglyconate (Maxon)	Mono	PoIyester	81% in 14 days 59% In 28 days
Nonabsorbable
Cotton	Twisted fibers	Cotton fiber	50% in 6 months 30% in 2 years
Silk	Braided	Silkworm spun fiber	Gone in one year
Steel	Mono	Alloy Fe-Ni-Cr	Indefinite
Nylon (Ethilon, Dermalon)	Mono	Synthetic polymer	Loses 20% a year
Polyester (Mersilene)	Braided	Polyester	Indefinite
Polypropylene (Prolene )	Mono	Synthetic polymer

 

1. Determine Size of Suture
   1.  Size 0-7     0 largest         7 smallest
   2. Refer to Chart for usual recommendation

 

Size of Suture to Use
Face  (eyes, ears, nose, lip)	6-0
Extremities	4-0
Scalp	4-0
Trunk or Foot	3-0 or 4-0
Oral mucosa, Brow, Penis,	5-0
G tubes or Chest Tubes	2-0 or larger

Note this is a general guide one must use judgment, for example a child with a fine eyelid lac may need a 6 or 7-0 vs 5-0 on the face! You get the idea.

Now the Fun Part Lets Practice some Sutures!!

Remember approximate don’t strangulate and “pucker your wounds”.

1. What type of suture to place
   1. Simple interrupted (most common)
   2. Mattress (for large tension wounds)
   3. Subcuticular or Running stitch
   4. 3 point suture for triangular laceration

 

1. When to have your patient return for Suture Removal
   1. Give good Wound care instructions (signs symptoms to look for, topical abx etc..)

•Face and head – 5-7 days

•Trunk – 7 days

•Arms – 8 days

•Hands – 8-10 days

•Legs – 9 days

•Feet – 10 days

1.  
   1. Children – about 1 day less at each site

Note this is in accordance with Annals of Emergency Medicine, again use your judgment based of type of wound and pt reliability.

Other Topics like undermining and removing “dog tails”, nerve blocks etc. will be discussed in other lectures.

 

Disclaimer: The above hand out and lecture is to serve as a recommended suggestion for suture repair. For a full understanding and current guideline recommendations for laceration repair please refer to Roberts  and Hedges Clinical procedures in Emergency Medicine.

Resources Used:

1. Hollander JE – Ann Emerg Med – 01-SEP-1999; 34(3): 356-67 Laceration management. Annals of Emergency Medicine – Volume 34, Issue 3 (September 1999).