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Suture Workshop
Bryan Combs, MSN, CRNP, FNP-BC, CNL, ATCUniversity of Alabama at Birmingham
Overview
• For emergency provider average laceration is 1 cm. - 3 cm. (0.4 in. – 1.2 in.)
• Infection most common complication – 3.5% - 6.3% of lacerations– 13% of lacerations were considered significantly
contaminated– Most important step to prevent infection wound
irrigation– 95% of glass in wounds is radio-opaque and
radiographs recommended
Overview
• Etiology– Blunt Object – 42%– Sharp (non-glass) –
34%– Glass – 13%– Bites• Dog – 3%• Human – 1%• Other – 2%
• Locations–51% - Face/Scalp–34% - upper
extremity–13% - lower
extremity
Anatomy
DEEP FASCIA
PERCUTANEOUS
Wound Healing
Wound Healing
Infiltration and Anesthesia
Infiltration and Anesthesia
Infiltration and Anesthesia
Infiltration and Anesthesia
Infiltration and Anesthesia
Irrigation & Cleansing
– The most important step– Providone-iodine solution (not scrub prep) most
effective skin cleanser– Water or Saline best option for wound irrigation
and debridement– Hydrogen peroxide not recommended due to
more negative then positive effects– Never shave the eyebrow– Make sure to numb them first
Irrigation & Cleansing
Irrigation & Cleansing
Closure Basics
Some text say this is wrong
And this is correct
Closure Basics
Some text say this is wrong
And this is correct
I say what is most
comfortable
Closure BasicsRemember Back 1/3 and perpendicular
Clos
ure
Basi
cs
Closure Basics
The index finger is important with scissors and provides steadiness and precision
Clos
ure
Basi
cs
Closure Basics
Clos
ure
Basi
cs
Closure Basics
A Cutting Needle has Cutting Edge on Inside of needle
Reverse Cutting NeedleCutting Edge on
Outside
Tapered Needle
Excisions
Excisions
Excisions
Basic Repair• Layer Matching– Stay level as
needle advances from one side of wound to other
Basic Repair• Wound Edge
Eversion – Point of
needle needs to be 90-degree angle when piercing skin
Wound Tension
The farther sutures are apart the more tension on wound and skin
The closer sutures are together there is less tension on wound and skin
The Simple Suture Knot
The knot is the crucial step in suturing
The way I remember: 3/1/1 and always opposite
1st – wrap suture clockwise around needle holder 3 times
2nd – grab the end of the “pig tail” and pull to the pig across the street
3rd – wrap suture counter clockwise around the needle holder 1 time
4th – grab the end of the “pig tail” and pull to the pig across the street
5th - wrap suture clockwise around the needle holder 1 time
6th - grab the end of the “pig tail” and pull to the pig across the street
Simple Suture
Simple Suture
1st – wrap suture clockwise
around needle holder 3 times
Simple Suture
2nd – grab the end of the
“pig tail” and pull to the pig
across the street
Simple Suture
Simple Suture
3rd – wrap suture counter
clockwise around the needle
holder 1 time
Simple Suture
4th – grab the end of the “pig
tail” and pull to the pig across
the street
Simple Suture
Simple Suture
5th – wrap suture clockwise
around the needle holder 1
time
Simple Suture
6th – grab the end of the “pig
tail” and pull to the pig across
the street
Simple Suture
Simple Suture
This examples only shows two knots but you
will see three done most of the time.
The second knot is the most important in
terms of locking it down
Instrument Knot Tie
https://www.youtube.com/watch?v=wbpQhiNDxvo
Simple Suture
https://www.youtube.com/watch?v=SYNHSDI69kk
Verti
cal M
attre
ss
Vertical Mattress
https://www.youtube.com/watch?v=UV-j1zxckXA
Hor
izont
al M
attre
ss
Horizontal Mattress
https://www.youtube.com/watch?v=8QYEXw76CPE
Dee
p Su
ture
Runn
ing
Sutu
re
Running Mattress
https://www.youtube.com/watch?v=ODZtJL_gb4E
Subc
uticu
lar
Runn
ing
Sutu
re
Subcuticular Running Mattress
https://www.youtube.com/watch?v=iYts9c6Jrx8
Pull Out Dermal Suture
Beveled Edge or Wound
You have to get a bigger bite on beveled side
Dealing with Corners
Dealing with Corners
Parallel Lacerations
PRACTICE MAKES PERFECT
PRACTICE, PRACTICE, PRACTICE
Find a way to Practice
• All kinds of ways to practice–Eggplant–Meat with skin–Purchase mold device–Make your own•Be creative
References
• Trott, A. (2012), Wounds and Lacerations• Campo, T. and Lafferty, K. (2011), Essential
Procedures for Practitioners in Emergency, Urgent, and Primary Care Settings
