Skin Techniques

Question 1

Goals of Wound Closure

Answer 1

• Obliterate dead space
• Distribute tension evenly
• Maintain tensile strength across wound
• Approximate and evert the epithelium

Question 2

Complications of Wound Closure

Answer 2

• Hypertrophic scars
• Wide scars
• Wound dehiscence
• Infection

Question 3

Suture material generally categorized by three characteristics:

Answer 3

–Absorbable vs. non-absorbable

–Natural vs. synthetic

–Monofilament vs. multifilament

Question 4

Suture Size

Answer 4

Zero is reference size - more zeros is smaller

Question 5

Simple interrupted stitch

Answer 5

Single stitches, individually knotted, keep all knots on one side of wound

Used for uncomplicated laceration repair and wound closrue

Question 6

Horizontal Mattress

Answer 6

Added strength - use in calloused skin (palms, soles)

Two step - 1 simple stick, need reversed and 2nd simple stitch made adjacent to first

Question 7

Vertical mattress stitch

Answer 7

Precise approximatoin of skin edges w/ eversion

Two step - simple stitch made far to far, needle reverse and make near near

Question 8

Type of suture and timing of removal by location

Answer 8

Arms 4-0 ⇒7 to 10

Face 5-0 or 6-0 ⇒ 3 to 5

Hands or feet 4-0 or 5-0 ⇒ 10 to 14

Legs 4-0 ⇒ 10 to 14

Palms or soles 3-0 or 4-0 ⇒14 to 21

Scalp 4-0 ⇒ 7 to 10

Trunk 3-0 or 4-0 ⇒ 10 to 14

Question 9

ABCDE system for malignancy

Answer 9

Geometric Asymmetry in two axes

Irregular Border

At least two different Colors in lesion

Maximum Diameter > 6 mm

Evolution of lesion