Chapter 42. Lacerations: Suturing

• 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.

• 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.

• Infection.

• 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.

• The patient should be lying flat or sitting.

• Figure 42–1 is a diagram of a 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 repair.

• • Epinephrine may be added to reduce local bleeding but is contraindicated in end organs (eg, penis, toes, fingers, nose, pinnae).

  • Sodium bicarbonate can be combined with lidocaine to reduce pain associated with infusion.

• When ...