Lacerations: Suturing

Indications

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  • • Improve cosmesis.

    • Reduce infection.

    • Restore function.

Contraindications

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  • • Wounds on the trunk and torso that are greater than 12 hours old.

    • Wounds on the face that are greater than 24 hours old.

    • Puncture wounds.

    • Heavily contaminated wounds.

    • Bites, especially in areas of limited blood flow.

Equipment

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  • • Sterile gauze.

    • Sterile towels, drapes, and gloves.

    • Saline.

    • Sterile basin.

    • Detergent cleanser (Sur-Cleans) or povidone-iodine solution.

    • Suture material (Tables 42–1 and 42–2).

    • 30–60-mL syringe for irrigation (splash adapter optional).

    • Syringe with fine needle (25–30 gauge) for local analgesia infusion.

    • Suture scissors.

    • Needle holders.

    • Forceps with teeth.

    • Local anesthetic.

Table 42–1. Surface wound closure guidelines.
Table 42–1. Surface wound closure guidelines.
Site Suture Material Suture Removal
Face 6-0 absorbing or nonabsorbing 5 days
Scalp 5-0 nonabsorbing 7–10 days
Digits 5-0 nonabsorbing 7–10 days
Palms/soles 2-0, 3-0, 4-0 nonabsorbing 7–10 days
Torso 4-0, 5-0 nonabsorbing 7–10 days
Joint 3-0, 4-0, 5-0 nonabsorbing 10–14 days
Table 42–2. Suture material.
Table 42–2. Suture material.
Name Material Reactivity Strength Absorption and Characteristics
Absorbable
Gut Monofilament Severe Good 7–10 days
Fast absorbing gut Monofilament heat treated Moderate Good 5–7 days
Chromic gut Monofilament chemically treated Severe Good 10–14 days
Polyglycolic acid (Dexon) Braided Mild Very good 60–90 days
Polyglactin 910 (Vicryl) Braided Mild Very good 55–70 days
Polyglecaprone (Monocryl) Monofilament Minimal Very good 90–120 days
Nonabsorbable
Silk Braided Severe Good Easy to handle; ties well
Nylon (Ethilon, Dermalon) Monofilament Mild Very good Slippery; requires many knots
Polypropylene (Prolene) Monofilament Minimal Excellent Slippery; requires many knots

Risks

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  • • Infection.

    • Stitch extrusion.

Pearls and Tips

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  • • Suturing requires a calm and unhurried approach.

    • The practitioner should be comfortable, since preparation and closure of even small lacerations in children may require more time than initially expected.

    • Determine the circumstances and mechanism of injury (eg, blunt or sharp) and risk of contaminants or retained foreign body.

    • Obtain past medical history (including allergies, status of tetanus immunization, medication use, and chronic diseases), since specific medications, such as corticosteroids, and conditions, such as diabetes, delay wound healing.

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Jan 4, 2019 | Posted by in PEDIATRICS | Comments Off on Lacerations: Suturing

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