Wound Management

Question 1

What size and locations make higher rates of infections?

Answer 1

length greater than 5 cm, and non–head-and-neck

Question 2

What should you remove right away whenever there is an injury to the hand?

Answer 2

remove rings

Question 3

Pros and cons of sutures

Answer 3

strongest and most accurate but most time consuming and likely needle stick risk

Question 4

when do you use absorbable sutures

Answer 4

do not need to be removed

Question 5

what are the suture sizes for
scalp
face
trunk
extremeties
digits

Answer 5

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

Question 6

what do the number of knot times correspond to for simple interrupted

Answer 6

suture size

4-0 = 4
5-0 = 5

Question 7

what would you use for a long linear wound

Answer 7

running stitch
Avoided in irregular wounds

Question 8

what are buried dermal used for

Question 9

what is the most cosmetic suture

Answer 9

Cutaneous subcuticular

Question 10

what is vertical mattress used for

Answer 10

deep wound (chunk of tissue)

Question 11

what is horizontal mattress

Answer 11

better for angled flaps of skin and pulling the skin closer for eversion

disadvantage = skill dependent

Question 12

what are staples used for and cons

Answer 12

non-facial, linear lacerations
staple removal is painful

super easy though

Question 13

steri-strips/ tapes pros/cons

Answer 13

least strong (needs to be low tension) but least invasive

good for smaller skin tears

come off in a couple days

Question 14

dermabond is typically used in

Answer 14

kids

it burns a bit, needs to be dry before or else it will not stick

a little weaker than staples

Question 15

What is the mangamenet of face/scalp lacerations

Answer 15

1. cleanse
2. do not cut (because there is a lot of blood supply)
3. consider a regional nerve block
4. use a 6-0 nonabsorbable monofilament

Question 16

best cosmetic results of face/scalp laceration?

Answer 16

1. Forehead wounds that fall parallel to the lines of skin tension (and perpendicular to muscle fibers) yield the best cosmetic results.
2. Close scalp lacerations with surgical staples or simple interrupted percutaneous sutures using nonabsorbable monofilament or rapidly absorbable material.
3. Leave suture tails long, and use sutures of a color different than the hair for easy suture removal.

Question 17

eyebrow laceration management

Answer 17

Use care to align the hair margins.
Use sutures that are a different color from the hair and leave long tails to facilitate removal.

Question 18

What are the indications for eyelid suturing

Answer 18

Eyelid injuries within 6 to 8 mm of the medial canthus are at risk for canalicular laceration, especially if associated with medial wall blowout fractures.

Refer the following injuries to an ophthalmologist or oculoplastic specialist: (1) injuries involving the inner surface of the lid, (2) wounds across lid margins, (3) injuries to the lacrimal duct, (4) wounds associated with ptosis, or (5) injuries extending into the tarsal plate

6-0 or 7-0 nonabsorbable monofilament for simple interrupted percutaneous sutures.

Avoid deep penetration of the needle through the lid and into the underlying globe.
Do not use tissue adhesive near the eye, as adhesives may abrade the cornea or bond the lids together

Question 19

What is the managment of a nose injury

Answer 19

really important to evaluate the thickness because there can be a pathway to the brain
look for septal hematomas

complications = erode septum, saddle deformity, obstruction

check for clear fluid (CSF)

Question 20

what is a through and through managment of nose

Answer 20

With extensive wounds, consider a loose anterior nasal pack with antibiotic-impregnated gauze to prevent scar contracture.

Question 21

what is the managment of superfiscial nose injury?

Answer 21

Superficial lacerations to the skin layer: 6-0 nonabsorbable monofilament simple interrupted sutures.

preserve cartilage

Question 22

Management of ear closure

Answer 22

close superfisical layers with 6-0
do not remove cartilage
do not debride edges of aurical laceration

Question 23

when do you not need to lacerate?

Answer 23

Mucosal lip lacerations may not need to be sutured if they are isolated and the wound edges spontaneously approximate.

the wet part of your lip

Question 24

when should you use absorbable vs non absorbable sutures for lips

Answer 24

absobable for wet part
non for dry part

both with 5-0 because it is

first stitch is at the vermilion border

remove in 5 days - do not bite or play with it

Question 25

How should through and through lacerations be closed if they do not have the vermilion border

Answer 25

1. closed in layer
2. Close the mucosal layer with a 5-0 rapidly absorbable suture followed by gentle reirrigation from the outside.
3. Next, approximate the orbicularis oris muscle fascia with 4-0 or 5-0 absorbable suture material with a simple interrupted or horizontal mattress technique.
4. Finally, after repeat irrigation, suture the skin with 6-0 nonabsorbable monofilament sutures in a simple interrupted fashion or use tissue adhesive

Question 26

Wounds that cross the vermilion border should be repaired by placing the first stitch with _____ suture to precisely align the edges of the vermilion border

Answer 26

6-0 nonabsorbable monofilament

Question 27

What is the management of intraoral lacerations

Answer 27

none
can drip lidocaine
5 mm a part if needed

Question 28

how to repair a cheek face

Answer 28

6-0
if parotid refer

Question 29

when do you remove sutures for face? staples? nasal packing?

Answer 29

sutures = 3-5 days
scalp = 14 days
nasal packing = 1-2 days

Question 30

When do yo uneed to close wounds for arms/hands

Answer 30

12 hours after may be prone to infection

Question 31

what suture do you use for hands/arms

Answer 31

hand = 5
arms = 4

tendon = hand surgeon

Question 32

what is a subungal hematoma

Answer 32

slamming a fingernail (nail bed injury)

Question 33

treatment of subungal hematoma

Answer 33

can decompress if needed
do not remove nail bed for cosmetic

Question 34

when would you remove the nail bed?

Answer 34

only if there is associated partial nail avulsion or surrounding nail fold disruption

Nail removal can be accomplished with adequate anesthesia, elevation of the nail off the nail bed using iris scissors, elevation of the eponychium off the nail, and then removal by gentle longitudinal traction with a hemostat.
Digital tourniquet application to the digit may be required to adequately visualize the extent of nail bed laceration.
Lacerations of the nail bed should be carefully repaired using 6-0 absorbable sutures to provide a smooth surface so the nail can grow without cosmetic deformity

Question 35

what is the imaging for foot and leg laceration?

Answer 35

suspect fracture, radiopaque foreign body, or joint penetration is suspected

Question 36

foot and leg
suture size
removal

Answer 36

consider delayed primary closure in cases of delayed presentation or heavy contamination

Suture size: 4
10-14 days removal