• Improve cosmesis.
• Reduce infection.
• Restore function.
• 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.
• Sterile gauze.
• Sterile towels, drapes, and gloves.
• 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
• Suture scissors.
• Needle holders.
• Forceps with teeth.
• Local anesthetic.
Table 42–1. Surface
wound closure guidelines. |Favorite Table|Download (.pdf)
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. |Favorite Table|Download (.pdf)
Table 42–2. Suture
|Name||Material||Reactivity||Strength||Absorption and Characteristics|
|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|
|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|
• Stitch extrusion.
• 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.
Diagram of skin laceration.
• Use universal precautions.
• Document laceration length and depth.
• Assess neurovascular status and investigate for tendon, muscle,
or vascular injury.
• Lidocaine is the most commonly used anesthetic for simple wound
• Epinephrine may be added to reduce local bleeding but
is contraindicated in end organs (eg, penis, toes, fingers, nose,
• Sodium bicarbonate can be combined with lidocaine to ...
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