Trauma Symposium Extra Reading page 8-15

Question 1

what questions to ask if a pt comes with soft tissue injury?

Answer 1

how did the injury occur?
to determine if its contaminated (compromised outcome) or if theres likely to be a foreign body?

has tetanus toxoid been given(by A & E worker)?
to ensure injury isnt contaminated with clostiridium tetani bacteria (risk of death). deep complex wounds = more risk of C.tetani

are important anatomical structures involved?
facial nerve, parotid duct. nerves on both side should be tested before administering local anaesthetic, weakness should be reported to consultant before closing the wound.

tissue loss?
tissue lossis unusual even if it gives the appearance that there has been tissue lost, if tissue loss has occured, as long as wond can be closed without too much tension then it should be fine

wound edge viability?
if the tissue has been crushed then may appear to be bruised, may lead to loss of viability. need to then decided to remove the tissue or keep depending on site and healing capabilities of the area affected

undermining?
dog bites may not look too large and may be undermining the tissues damaged below the surface that isnt visible

timing and your skills?
large lacerations should be handled during normal working day rather than middle of the night with poor lighting, especially if feel skills arent as developed and need supervision whilst suturing. if suture is being delayed then ensure the laceration has been cleaned properly and dressed with wet gauze to ensure edges dont dry out and lose vitality

Question 2

what is the sequence of wound closure?

Answer 2

1. apply LA to wound edges
2. irrigate the wound with salineor chlorohexadine
3. eliminate dead space: use resorbable sutures deep within the wound to close dead space
4. close deep layers by vringing cut muscle edges together using resobable sutures
5. close the wound edges using non resobable suture- start in the middle of the laceration and divide into sections, suture all the sections one by one until completely closed
6. dress the wound for 24hrs with antiseptic ointment to reduce risk of infection
7. discharge pt with appropriate follow up - non resorbable sutures should be removed within 5-7 days after wound is closed

Question 3

what is the most commonly used suture in practice?

Answer 3

for intraoral and deep skin sutures, most commonly use size 3 vicryl suture

Question 4

what questions to ask when deciding which suture to use?

Answer 4

where am i suturing?

what is the purpose of the suture?

how much tension do i need?

how long do i want the suture to remain in the tissue?

will the suture need to be removed

Question 5

what suture material would you use if theres lots of tension?

Answer 5

size 2 prolene

Question 6

what suture would be used for accurate joining of skin edges?

Answer 6

size 5 ethilon

Question 7

what suture would be used for closure of lower eyelid incision

Answer 7

size 6 ethilon or size 4 subcuticular

Question 8

what suture would be used in skin suturing for cooperative adults?

Answer 8

size 5 ethilon

Question 9

name some resorbable sutures used?

Answer 9

vicryl (socket suture)
monocryl (subcuticulur closure)
PDS (deep suture under tension)

Question 10

name some non resorbable sutures used?

Answer 10

ethilon (cosmetic skin closure)
prolene (cosmetic skin closure)
natural mersilk (drain suture)