Suturing

Question 1

where do platelets head?

Answer 1

high velocity keeps platelets midstream

• bleeding slows velocity and allows platelets to drift to exit point
• pro-inflammatory cytokines are first responders
• the fresher the wound, the better it will heal

Question 2

3 principles of wound repair

Answer 2

1. minimize trauma to tissue
2. minimize tension on wound edges (approximate, don’t strangulate)
3. accurately approximate wound edges and landmarks

Question 3

3 phases of wound healing

Answer 3

1. inflammatory phase: immediately, lasts for 5 days
2. proliferative phase: starts in 24 hours and continues for 6 months - seals wound from water
3. remodeling phase: continues up to two years.

Question 4

what should you close?

Answer 4

• fresh wounds
• large clean wounds
• wounds over cartilage or bone
• reduces scarring
• reduces bleeding
• if after a long time need to : surgically debrided and irrigated wounds

Question 5

what don’t we close?

Answer 5

• old wounds: days to weeks old
• abscess that are drained
• wounds that have opened after previous repair
• foreign bodies in the wound

Question 6

how do wounds heal best?

Answer 6

laceration wounds heal best from bottum up: fluid and debris is pushed up and out as the bottom closes

if close a puncture wound early, the skin will try to push the bad stuff out, but will form an absess or a boil

Question 7

ABCD’s of wound closure. layers of closure?

Answer 7

• the pieces of the wound will try to pull apart at the top and the bottom, causing shear forces in the middle: first layer width of the wound, wound will widen out if underneath layers aren’t controlled, and scar will turn out to be as wide as original insult
• need to go opposite how the insult went through, start at lower muscle layer, then close skin layer.

Question 8

which direction should you close?

Answer 8

along Langer’s lines

Question 9

what if defect is wider than usual?

Answer 9

undercut or undermine the wound

• cut out about 2/3 width of wound
• then you can approximate the wound without stretch it out

Question 10

look at different techniques

Answer 10

look at different techniques.

• interrupted sutures
• continuous running suture
• running lock suture
• verticle mattress suture
• pulley stitch
• horizontal mattress suture
• running subcuticular closure*