Splints & Wound Closure Flashcards
Volar Wrist Splint
- For stable wrist fractures
- Restricts wrist flexion and extension
- Splint to the MCP level leaving fingers free
Sugar Tong Splint
- For forearm fractures
- Restricts elbow motion
- Restricts wrist flexion and extension
- Restricts pronation and supination
Short Leg Splint
- For ankle fractures, dislocations, ankle sprains, calcaneus and talus fractures, achilles tendon injury
- splint ankle at 90 degrees
When is wound closure contraindicated? (3)
- in wounds older than 12 hrs (24 hrs for facial wounds)
- Bite wounds (exception: if gaping or on the face)
- Puncture wounds
What are the 3 phases of wound healing?
- Initial lag phase (days 0-4)
- Fibroplasia phase (days 5-14)
- Final healing phase (day 15 to completed healing)
What types of wounds should be closed by “secondary intention”?
- active infx/inflammation
- stab/puncture wounds
- contaminated wounds
- wounds presented after significant period of time since injury
- abscess cavities
- animal bites
What are the goals of wound closure? (4)
- Hemostasis
- Cosmesis
- Infx prevention
- minimize discomfort
What to give for pasturella prophylaxis?
Augmentin 875mg PO BID x7 days
When to give antibiotics for a wound?
- Obesity
- Diabetes with LE wound
- Immunocompromised patient
- areas of higher bacteria (e.g. axilla, groin, mouth, etc.)
- significant wound contamination
- chronic steroid use
When to give tetanus?
- If less than 3 tetanus doses given
- If last dose given was more than 10 years ago (for minor wounds)
- If last dose given was more than 5 years ago (all other wounds)
Ulnar Gutter Splint
- For Boxer’s fracture, ulnar metacarpal injuries
- Splint MCP joints at 90 degrees, intrinsic plus position (as if holding a baseball)
When to consult/refer for wounds?
- Deep wounds of hands or foot
- full-thickness lacerations of eyelid, lip, ear
> Lip lacerations involving the vermilion border
> Ear cartilage wounds! ** prevent cauliflower ear
> Wounds to the eyelid that involve the tarsal plate - Lacerations involving nerves, arteries, bones, joints
- Severe crush injuries
- Penetrating wounds of unknown depth
- Severely contaminated wounds requiring drainage
- Wounds leading to a strong concern about cosmetic outcome
- Anything makes you feel uncomfortable as a provider treating the wound
How long do local anesthetics take for onset and how long do they last?
- Lidocaine w/o epi
onset: 1 min
lasts: 0.5-1 hr - Lidocaine w/ epi
onset: 5 min
lasts: 2-6 hrs - Bupivacaine w/out epi
onset: 5 min
lasts: 2-4 hrs - Bupivacaine w/ epi
onset: 5 min
lasts: 3-7 hrs
When is epinephrine in local anesthetic contraindicated?
In large wounds in patients with comorbid conditions:
- hyperthyroid
- CAD
- severe HTN (some epi is absorbed systemically)
- PAD
What are the benefits to adding epinephrine to local anesthetic? (3)
- decreases bleeding
- reduces systemic absorption of the anesthetic
- prolongs the duration of action of the anesthetic
What topical preparations can be used to numb the skin before injecting local anesthetics? (3)
- EMLA cream
- ethyl chloride
- LET gel
What can be added as a buffer to lidocaine?
1ml sodium bicarb per 10ml lidocaine
(neutralizes the pH)
What does suture size refer to? How to select size of suture?
Suture size refers to the thickness of the suture material.
Choose suture size based on skin thickness and wound tension, as well as anatomical location of the wound.
** the smaller the number, the thicker the suture size (such as with needle gauges)
3-0 or 4-0 on trunk
4-0 or 5-0 on extremities, scalp
5-0 to 7-0 on face
Clinical pearls about suture material?
- Braided (silk, polyester) are stronger, but can harbor bacteria. Avoid in contaminated wounds
- Monofilament (Prolene, nylon/ethilon) have a lower infx risk but are weaker
- Absorbable sutures (Vicryl) are good for deep multi-layer lacerations and mucosal lacerations (mouth, tongue, genitals) and absorb within 4-8 weeks
When to choose horizontal mattress sutures vs vertical mattress sutures?
Horizontal:
- Good for fragile skin
(elderly, chronic corticosteroid use)
- Good for hemostasis, gaping, high tension wounds
Vertical:
- Good in areas where skin tends to invert
- deep, deep, up, up
How many ties recommended when suturing?
3 ties
Surgeon’s knot?
1 double or triple throw
+ 3 single throws
Patient education tips for suture care?
- No shower x24 hours after sutures applied
- No pools, tubs, or natural bodies of water throughout healing
- Review symptoms of infection
- Scarring: Daily cleansing, petroleum or bacitracin, sunscreen
When to remove sutures?
** No longer than 14 days (skin will grow over sutures)
- Eyelids 3 days
- Neck 3-4 days
- Face 5 days
- Scalp 7-14 days
- Trunk and UE 7 days
- LEs 8 to 10 days
