Suturing and wound healing

Question 1

indications for suturing (5)

Answer 1

• decr healing time
• reduce likelihood of infection
• decr scar tissue
• repair loss of strucutre/function
• improve cosmetic appearance

Question 2

contra for suturing (3)

Answer 2

• wound has been opened past time frame of closure
• presence of FB
• extensive wounds: involve tendons, nerves, arteries

**technically no absolute contraindications but should be carefully considered

Question 3

potential complications from suturing/wound closure (6)

Answer 3

• infection
• scarring— keloids
• loss of structure/function
• loss of cosmetically desired apperance
• wound dehiscence
• tetanus

Question 4

epidermis is how thick

Answer 4

0.5-1.5 mm

Question 5

dermis is how thick

Answer 5

2 mm

Question 6

scubcu fat is best for

Answer 6

inject local anesthetic

Question 7

deep fascia

Answer 7

thick layer above the muscle bone and tendons

Question 8

1 inch = how many cm

1 cm = how many mm

Answer 8

1 inch = 2.5 cm

1 cm=10 mm

Question 9

how deep is a laceration needing suturing

Answer 9

extends deep into subcuatneous tissue–may need 2 layers of suturing

Question 10

does injury to fascia need repair?

Answer 10

yes

Question 11

skin tension lines

Answer 11

langer lines

Question 12

lacerations that are ______ to the langer lines approxximate well

Answer 12

parallel will approximate well

Question 13

lacerations that are ____ to langer lines will gape apart

Answer 13

perpendicular

Question 14

primary intention wound closure

Answer 14

clean wounds

minimal scarring

Question 15

secondary intention

Answer 15

heal on its own or only deep layer closed— allow irrigation and packing
-prolonged process— leaves wide scar

Question 16

third intention (delayed primary)

Answer 16

deep layer closed–checked in 4-5 days– if clean will close wound
-arise from contaminated wounds

Question 17

good locations to use absorbable suture

Answer 17

mouth
tongue
subcutaneous
surgery

Question 18

types of absorbable suturing

Answer 18

• chromic gut
• VICRYL***** –>braided synthetic
• monocril—monofilament synthetic

Question 19

types of non-absorbable suture (3)

Answer 19

polyporpyele

Silk

Nylon–MC

Question 20

silk suture indications

Answer 20

secure chest tube

central line

Question 21

which suture passes through tissue more easily

Answer 21

monofilament

Question 22

which suture has the most tensile strength

Answer 22

multifilament

Question 23

which suture has better flexibility

Answer 23

multifilament

Question 24

which suture can harbor more infeections

Answer 24

multifilament bc of the braid

Question 25

larger the number, the _____ the thread

Answer 25

smaller 6-0 < 3-0

Question 26

size suture to use on - scalp - face - trunk - extremities - digits

Answer 26

scalp= 3-0 or 4-0 face= 6-0 trunk= 4-0 extremities = 4-0 digits= 5-0

Question 27

tripod grip

Answer 27

1st and 4th fingers

Question 28

what angle to cut

Answer 28

45 degree

Question 29

verticle mattress stich | -inds

Answer 29

far-far/ near-near 2nd mC suture INDS: used to close deeper wounds (superficial and deep) -done to eliminate dead space

Question 30

2nd mc suture?

Answer 30

vertical mattress sittch

Question 31

horizontal mattress stitch

Answer 31

looks like a box | knot is brought down parallel

Question 32

tetanus shot is given every?

Answer 32

10 years

Question 33

tatanus shot is given ___ yrs if dirty wound

Answer 33

5 years

Question 34

is tetanus ok in pregn?

Answer 34

yes

Question 35

tetanus prone wound?

Answer 35

``` >6 hrs >1 cm deep avulsion contaminated GSW step on nail ```

Question 36

how to irrigate, debride wound

Answer 36

30-60 ml syringe with splash guard

Question 37

local anesthesia drug class? concentrations onset doa

Answer 37

LIDOCAINE class: -amide concentrations: 0.5, 1, 2 onset: rapid doa: 20-120 min

Question 38

absolute contra to epinephrine

Answer 38

- uncontrolled HTN - severe CAD - narrow-angle glaucoma

Question 39

why do we use epipehrine

Answer 39

controls bleeding

Question 40

what can we add to minimize burning sensation

Answer 40

sodim biacrb

Question 41

where can NOT use epi

Answer 41

``` digits tip of nose penis pinna of ear ***necrosis**** ```

Question 42

local block - how to inject - layers of skin - when do u stop injecting

Answer 42

inject directly - between the dermins + subcutaneous tisue - continue until all around edges are raised

Question 43

digital block indications

Answer 43

- used for nail avulsion - drainage of parynoychia - lac of digits

Question 44

three other ways to close wound that arent suturing

Answer 44

skin stapler dermabond steristrips or butterfly stiches

Question 45

after how many days do you remove sutures/staples on: - scalp - face - hands - extrems/trunk

Answer 45

Scalp= 7-10 days face= 4-5 days hands=7-10 days extrems/trunk=10-14 days

Question 46

lining on top of the lip?

Answer 46

vermilion border