Procedure - Laceration Repair Flashcards
What is the max dose of lidocaine?
- With epinephrine: 7 mg/kg (max of 500 mg)
- Without epinephrine: 5 mg/kg (max 300 mg)
1% solution has 10 mg/mL
2% solution has 20 mg/mL
What are the indications for repairing a tongue laceration?
- Long lacerations (greater than 2 cm)
- Gaping lacerations (does it stay open when the tongue is at rest?)
- Lacerations that go through the edge of the tongue (to avoid split tongue healing)
- Uncontrolled hemorrhage
Review the basics of sutures (material selection, removal timeline.
- Use thinner sutures for thinner skin, and thicker sutures for thicker skin. Also, use thicker sutures for joint surfaces. For example, eyelids use 7-0, face use 6-0, trunk and extremities use 5-0, joint surface 4-0, foot sole use 3-0.
- For deep tissue layers use absorbable. For superficial use non-absorbable because they are tougher.
- For reapproximations of questionable viability, have the patient seen in 3-4 days for assessment. Otherwise, sutures can be removed in 5-10 days. Generally, joint surfaces and areas with a lot of movement should be longer (like 10 days) whereas trunk and face can be shorter (like 5 days).
Review the basics of laceration management.
- Clean the wound to look for tissue layers. If the lac extends into muscles/tendons or into a body cavity then surgical specialists should evaluate.
- Consider ordering an x-ray to evaluate for foreign bodies.
- Assess tetanus status.
- Irrigate with saline, clean with betadine if cannot be adequately irrigated.
- Numb with LET, intradermal lidocaine
- Consider antibiotics if deep puncture or animal bite.
What implement do you use to hold the needle?
The needle driver – long straight forceps
How should you hold the needle driver?
Put your index finger on the distal tip just proximal to the needle and use your thumb, middle finger, and ring finger to stabilize the base.
This allows you to have stability and control the depth of your needle.
When you’re pulling your knot tight, be sure to pull ____________________.
horizontally, that is, don’t pull up
If you pull up, you will loosen your knot. Pull toward yourself with one hand and away from yourself with the other.
Which body part is the exception to the “never suture bites” rule?
The face
The face has an excellent blood supply and is thus great at fighting infection. The face is also cosmetically very important and repair can help to heal cleaner.
In general, never repair a laceration that is older than _______.
24 hours
Why should you use a sterile drape?
You should not drag the suture across a non-sterile surface like the bed, the table, or the patient.
Which areas do you need to sterilize on the wound?
Only the areas you intend to put the needle through. You should not insert a needle through non-sterile skin.
What areas of the body are most and least likely to get infected?
Scalp and face are least likely because of high vascular supply. Thigh is most likely to get infected for unknown reasons. Feet are also high to get infected.
What factors should you consider in starting prophylactic antibiotics?
Essentially the likelihood of getting infected:
- Is the patient immunocompromised (chemo, transplant, diabetic, vascular disease, elderly)?
- Is it a high likelihood spot to get infected (like the legs or feet)?
- Is it a deep wound?
- Has it been longer than 12 hours since the injury?
The part of the needle that connects to the thread is called the __________.
swage
What is gut made of?
Animal products (high collagen tissue)
