Stitches (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Why is wound closure important?
- How does the health-care provider assess a wound?
- How is the type of closure material chosen?
- How is skin closure achieved?
- How is repair of deep tissues achieved?
- When and how are sutures removed?
- What happens to the site after suture removal?
- Are there any special considerations regarding wound repair?
- Stitches At A Glance
How does the health-care provider assess a wound?
Lacerations are common injuries that are seen in physicians' offices and emergency departments. The approach to the injury is often the same. The history taken by the health-care provider is very important to decide whether the benefit of repairing the wound outweighs the potential risk of complications, most often infection. The provider will want to know the circumstances of the injury.
- Where did the accident occur? Was it washing dishes in the sink, or did it occur in a farm field, cleaning dirty equipment covered in mud?
- When did it happen? The older the wound, the higher the potential for infection.
- Was it due to a fall or other trauma so that other parts of the body might be damaged?
- Were there unusual circumstances, like an animal bite, or did it occur underwater in a river or lake (both situations being at high risk for infection)? One can imagine a variety of scenarios in which infection risk is great.
Physical examination is key to making certain that underlying structures are not damaged. This is especially important in the extremities where arteries, nerves, and tendons run beneath the skin. When skin is damaged over a broken bone, it is called an open fracture, and often patients with such a fracture are taken to the operating room so that the wound can be extensively cleaned to prevent osteomyelitis (an infection of the bone). This same situation may also occur if the laceration goes deep into a joint.
X-rays may be taken, looking for foreign material that may be imbedded in the laceration. While metal objects are easier to see, nonmetallic foreign objects may also be identified.
Once the decision is made to repair the wound, the health-care provider has many options: sutures, staples, glue, Steri-Strips, and Band-Aids. But first the wound needs to be prepared for sewing (or suturing or stitching; the words all describe the same procedure).
- Ideally, the injured area is exposed and cleaned with water, saline (salt water), and/or soap.
- A local anesthetic is administered to allow full exploration of the wound, looking for foreign objects or damage to underlying structures.
- The wound may again be washed or irrigated to try to minimize the risk of infection.
http://www.medicinenet.com/stitches/article.htm
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