Suturing Workshop Dr Samantha Murton MBChB Otago , FRNZCGP
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Transcript of Suturing Workshop Dr Samantha Murton MBChB Otago , FRNZCGP
Suturing WorkshopDr Samantha Murton
MBChB Otago, FRNZCGP
Registrar TrainingSeptember 1st 2011
Auckland
Preparation
• The 12 things you need• Drawing• Langers lines• Margins – Naevi, benign appearing 1-2mm - BCC 3-5mm - SCC 5-10mm - Melanoma 5 – 20mm
Anaesthesia
• 1% lignocaine with 1:100,000 adrenaline, variety of others
• No adrenaline on digits• 7 minutes to full effect of adrenaline
Elliptical excision
• The shape of the hull of a boat• Try to get a good amount of fat under lesion
Suture Material
• Absorbable and non-absorbable• 3.0 to 6.0• How long to leave it in– Face 5 days– Neck/scalp 5-7 days– Trunk 7 – 10 days– Back and limbs 10 – 14 days
Types of Suturing Styles
• Interrupted• Continuous• Mattress• Subcuticular
How to Make it look good
Subcuticular
• Use absorbable suture• Evert the skin
Deep Sutures
• Most wounds could do with them• Helps with haemostasis• Takes tension off skin• Absorbable suture• Bury the knot
Dressing
• Steristrips along wound take the tension off• Some may require pressure dressing for a
couple of days• Skin adhesive may help with dressings to stick• Micropore• Suture guide/care of wound guide
Rhomboid Flap
• Good on back or places where adequate tissue to move and big lesion to excise
• Make sure well marked out • No tension on wound• Close flap wound first then defect• Continuous suture