Suturing - Amplified
Wound Assessment
History
- Mechanism (clean vs dirty)
- Time since injury (<6-8h ideal)
- Tetanus status
- Allergies (lignocaine, chlorhexidine)
Examination
- Depth (superficial vs deep structures)
- Contamination
- Neurovascular status distal
- Tendon function
Local Anaesthesia
Lignocaine
- 1% = 10mg/mL
- Max dose: 3mg/kg (or 7mg/kg with adrenaline)
- Duration: 1-2 hours (4-6h with adrenaline)
Injection Technique
- Use fine needle (25G)
- Inject into wound edges (less painful)
- Allow 2-3 minutes for effect
- Test before suturing
Adrenaline Contraindications
- End arteries: fingers, toes, nose, ears, penis
- Cardiac arrhythmias
Suture Selection
By Location
| Site | Size | Material | Removal |
|---|---|---|---|
| Face | 5-0 or 6-0 | Non-absorbable | 5 days |
| Scalp | 3-0 or 4-0 | Non-absorbable or staples | 7-10 days |
| Trunk | 3-0 or 4-0 | Non-absorbable | 10-14 days |
| Limbs | 4-0 | Non-absorbable | 7-10 days |
| Joints | 4-0 | Non-absorbable | 10-14 days |
Material Types
Non-absorbable: Nylon, Prolene (skin) Absorbable: Vicryl, Monocryl (deep layers)
Technique
Simple Interrupted
- Enter perpendicular, 3-5mm from edge
- Exit through wound, cross, enter wound
- Exit perpendicular, 3-5mm from edge
- Square knot (flat, not too tight)
- Cut tails 3-5mm
Principles
- Evert wound edges (don't invert)
- Equal bites on each side
- Sutures 5-10mm apart
- Tension just enough to approximate
Complications
- Infection: redness, warmth, discharge
- Dehiscence: wound reopening
- Scarring: worse with tension, delayed closure