Basic techniques

That somehow everyone doesn’t know

Wound care priorities

Discover and treat injuries to critical deep structure

Cover critical structures with skin Maintain function without contracture Prevent infection Cosmesis is a distant fifth priority

Basic techniques

Managing contaminated wounds Wound eversion Inverted dermal sutures as primary closure Instrument tying

Managing contaminated wounds

Never close an infected wound If wound merely contaminated, clean it up

and then make a decision for primary, secondary or tertiary (delayed primary closure)

Timing of delayed closure in contaminated wound

Managing contaminated wounds

Debride all dead or marginal tissue (if unsure cut a little, does it bleed?)

Remove all foreign debris When irrigation needed use either a

hydrostatic irrigator or a 10 cc syringe with an 18 ga angicath or Zerowet

Klenzalac irrigation tray

Managing contaminated wounds

If wound is over 6 hours old and exudative, prep it, then gram stain it for white cells and/or bacteria

Frequently, where there are no important structures and skin is loose enough to avoid tension, better simply to excise a dirty wound, then close it

Wound excisionScore skin in ellipse

Excise wound with scissors or scalpel

Undermine excised wound to allow eversion on closure

Evert to allow flat scar after healing

Use dermal stitches as primary closure allows natural eversion from technique tissue 1/2 life of about a month allows for

far longer support for healing than skin sutures

after dermal layer placed, often can close skin with rapid techniques (tapes, running suture, glue)

Wound is weakest when skin sutures are removed

Use dermal stitches as primary closure

Wound must be clean Technically a little more difficult than skin

sutures

Instrument tie

Surgeon’s knot Follow with at least three square throws Granny knots will lead to untieing

Driver in middle, two overhand throws

Grab loose tail

Cross hands to lay flat

Finish by

Placing needle driver between tails single overhand throw, grasp loose tail cross hands to lay flat at least 3 more throws