Suturing

Closure of Skin Lacerations:

Prepare the skin with aqueous Betadine or Trisept (make sure patient has no known allergies).

Infiltrate area with local anaesthetic—be careful of using adrenaline in ischaemic looking tissues.

Clean, debride and irrigate with saline.

The depth of the wound should be carefully assessed to determine whether the facial muscles have been divided. The muscle should be carefully repaired using absorbable sutures. Failure to repair the muscle layer will result in a sunken scar, giving an unsatisfactory cosmetic result.

Aim to try and preserve as much skin as possible, as the vascularity of the face usually ensures good healing.

 

If deep sutures needed use 3/0 SGS or 3/0, 4/0 Vicryl undyed.

Use 5/0, 6/0 Prolene or Ethalon on the skin.

Prescribe 500mg Flucloxacillin QDS 3/7 or 500mg Erythromycin QDS 3/7 and Polyfax ointment.

Review on clinic in 5/7 for suture removal or to GMP.

Make sure patient is up-to-date with Tetanus vaccination.

 

Intra-oral/ vermillion border:

¨ Vicryl 3/0, 4/0, Softgut 3/0

¨ Chromic Catgut 3/0

Skin: normally use non-resorbable mono-filament to reduce scarring:

Eyelids:                Novofil 6/0

                          Prolene 6/0

Face:                   Novofil 5/0

                          Prolene 5/0

Scalp:                  Black Silk 3/0

                          Novofil 4/0, 3/0

                          Vicryl 3/0. 4/0

Children:             Novofil 5/0, 6/0

                          Vicryl 6/0 (fine enough that there is minimal scarring, but do not need to be                                removed).

Types of suture:

Braided:               Resorbable                        Vicryl

                          Non-resorbable                  Black Silk

Monofilament:      Resorbable                        Soft Gut

                                                                 Cat Gut

                          Non-resorbable                  Prolene  

                                                                 Novofil

                                                                 Ethilon

.

A large amount of your time in A&E will involve suturing facial lacerations. It is important to close wounds within 24 hours, as incidence of wound infection increases dramatically after this time.

Dog bites/

 Human bites/

Tongue lacerations

Types of stitch