Intro to Suturing and Wound Closure

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Questions and Answers

What is the primary purpose of using anesthesia in wound management?

To minimize bleeding during surgery

To enhance the options of suture materials

To ensure the patient remains conscious throughout the procedure

To allow examination and repair of wounds (correct)

Which factors can alter the overall effect of an anesthetic?

Patient's previous surgical history

Duration of the surgical procedure

Location and size of the wound (correct)

Type of surgical instruments used

Which of the following anesthesia agents has the longest duration without epinephrine?

Cocaine

Bupivacaine (correct)

Valproate

Lidocaine

Which of the following patient factors does NOT affect the success of anesthetic treatment?

Surgical instrument quality Signup and view all the answers

What is the primary goal when repairing a laceration?

Achieve hemostasis Signup and view all the answers

Which type of wound healing involves the use of sutures at the time of injury?

Primary intention Signup and view all the answers

Which phase of wound healing is characterized by clot formation and the initial inflammatory response?

Hemostasis phase Signup and view all the answers

What is the significance of the delayed primary closure technique?

Facilitates closure after ensuring the risk of infection is decreased Signup and view all the answers

Which type of suture material is specifically noted for not being absorbed by the body?

Nonabsorbable sutures Signup and view all the answers

What type of wound healing is typically favored for grossly contaminated or infected wounds?

Secondary intention Signup and view all the answers

Which anatomical structure is primarily responsible for providing structural support to the skin?

Dermis Signup and view all the answers

Which phase of healing involves the formation of new tissue and collagen synthesis?

Proliferative phase Signup and view all the answers

What is a crucial aspect to include in documentation after performing laceration repair?

Description of the procedure performed Signup and view all the answers

Which type of adhesive is most appropriate for closing superficial lacerations?

Tissue adhesive Signup and view all the answers

What is the maximum time allowed for suturing a laceration on the face?

24 hours Signup and view all the answers

Which factor can increase the risk of infection and impair healing in wounds?

Immunosuppression Signup and view all the answers

What type of imaging is useful for identifying wooden foreign bodies in a wound?

Ultrasound Signup and view all the answers

Which type of repair technique has the lowest risk of needle stick and is the least reactive?

Adhesives Signup and view all the answers

What symptom would likely NOT be included in the initial history taking for a laceration?

Blistering Signup and view all the answers

Which repair technique is NOT recommended for hairless areas?

Tapes Signup and view all the answers

Which of the following factors is NOT included in the evaluation of the initial history for a wound?

Family medical history Signup and view all the answers

What characteristic of sutures contributes to their tensile strength?

Meticulous application Signup and view all the answers

Which of these wound factors is associated with increased tissue loss?

Crush injuries Signup and view all the answers

What aspect is essential during a physical examination of a patient with a laceration?

Calm, cooperative patient Signup and view all the answers

Which type of anesthesia is often characterized by its fast-acting and short-duration effects for minor procedures?

Topical anesthesia Signup and view all the answers

What is the potential consequence of administering an anesthetic agent in an area with poor blood supply?

Decreased effectiveness of the anesthetic Signup and view all the answers

What is one important consideration when using Bupivacaine as an anesthetic agent?

It offers a longer duration of effect compared to many other agents. Signup and view all the answers

Which factor is least likely to influence the success of an anesthetic during wound management?

Type of surgical instrument used Signup and view all the answers

What is the maximum allowable dose of Lidocaine when combined with epinephrine?

5 mg/kg Signup and view all the answers

Which of the following is NOT a phase of wound healing?

Corticosteroid Phase Signup and view all the answers

What should be evaluated regarding the mechanism of injury during the initial history?

Type of injury and associated symptoms Signup and view all the answers

Which term describes closing a wound with surgical techniques at the time of injury?

Primary Intention Signup and view all the answers

In what circumstance is wound imaging particularly necessary?

When there is a high likelihood of a foreign body Signup and view all the answers

What is a primary goal of laceration repair?

Achieve hemostasis and prevent infection Signup and view all the answers

Which factor is crucial for assessing a patient's risk for impaired wound healing?

Presence of foreign bodies in the wound Signup and view all the answers

What is an initial action taken when implementing Delayed Primary Closure?

Inserting gauze between wound edges Signup and view all the answers

During the physical examination of a laceration, what is essential before administering anesthetic?

Conducting a functional examination Signup and view all the answers

Which structure in the dermis contributes to its elasticity?

Elastic fibers Signup and view all the answers

Which repair technique is characterized by lower tensile strength and requires careful handling during healing?

Adhesives Signup and view all the answers

Which type of wound healing typically requires no wound closure techniques?

Secondary Intention Signup and view all the answers

What is one significant characteristic of suture material that enhances its utility in laceration repair?

It possesses high tensile strength Signup and view all the answers

What must be monitored closely when performing laceration repairs?

Risk of infection Signup and view all the answers

Which type of imaging modality is least effective for identifying metallic foreign bodies in a wound?

Ultrasound Signup and view all the answers

Which of the following is essential for the evaluation of a patient presenting with a skin laceration?

Pertinent elements of the patient history and physical examination Signup and view all the answers

When documenting a patient's history concerning laceration, which aspect is least relevant to healing risks?

Social media usage Signup and view all the answers

During the evaluation of a wound, which might indicate the need for delayed primary closure?

Wound older than 12 hours Signup and view all the answers

What factor should not be included in the evaluation of the initial history for a wound?

Family history of lacerations Signup and view all the answers

What does the term 'proliferative phase' refer to in wound healing?

Collagen synthesis and new tissue formation Signup and view all the answers

Which symptom is commonly associated with lacerations and is crucial to document during the initial assessment?

Paresthesia Signup and view all the answers

Which anesthetic agent has the longest maximum duration without epinephrine?

Bupivacaine Signup and view all the answers

In which patient scenario is the success of anesthesia most likely to be impaired?

An elderly patient with peripheral vascular disease Signup and view all the answers

What is the maximum allowable dosage of Bupivacaine without epinephrine, measured in milligrams per kilogram?

3 mg/kg Signup and view all the answers

Which factor primarily affects the choice of anesthesia for a wound repair procedure?

The location of the wound regarding available nerve endings Signup and view all the answers

What is the primary consideration when using local anesthesia in a surgical procedure?

The total volume of anesthetic used per area Signup and view all the answers

Which type of wound healing is characterized by no attempt to close the wound initially?

Secondary intention Signup and view all the answers

What is the initial phase of wound healing that involves clot formation?

Hemostasis phase Signup and view all the answers

In the context of laceration repair, which of the following goals is NOT typically prioritized?

Promote infection Signup and view all the answers

Which type of suture material is preferable for use in nonabsorbable applications?

Silk Signup and view all the answers

What is a significant consideration when implementing delayed primary closure for a wound?

Wounds greater than 12 hours old can benefit from delayed closure Signup and view all the answers

Which of the following correctly describes the characteristics of the proliferative phase in wound healing?

Wound contraction and collagen deposition occur Signup and view all the answers

What is a crucial factor related to the dermis that influences its healing capacity?

Collagen and elastic fibers Signup and view all the answers

Which type of suturing technique is designed to minimize tension on the skin during healing?

Horizontal mattress suture Signup and view all the answers

What documentation aspect is least relevant when performing laceration repair?

Brand of suture material used Signup and view all the answers

What is a common complication to watch for after performing laceration repair?

Hematoma formation Signup and view all the answers

What aspect of the physical examination is critical before administering anesthetic for wound repair?

Performing a neurovascular examination Signup and view all the answers

Which imaging technique is specifically noted as useful for identifying objects with densities similar to soft tissue?

MRI Signup and view all the answers

In the context of laceration repair, which repair technique is known for having the least risk of causing foreign body reaction?

Adhesives Signup and view all the answers

Which wound factor is associated with increased healing risks and may impair healing significantly?

Ischemia in tissue Signup and view all the answers

During the initial history taking, which of the following details about the mechanism of injury must be specifically addressed?

Intentional or unintentional actions Signup and view all the answers

For which of the following wounds is the use of staples for repair considered the least appropriate?

High-tension areas Signup and view all the answers

In assessing symptoms during the initial evaluation of a laceration, which symptom is least likely to be specifically documented?

Psychological impact Signup and view all the answers

Which repair technique is best characterized by having a rapid application process without needle stick risks?

Adhesives Signup and view all the answers

What is a primary disadvantage of using adhesive for wound closure in hairless areas?

Cannot get wet Signup and view all the answers

Which factor is essential to evaluate regarding a patient's history that could lead to impaired wound healing?

Previous scar formation Signup and view all the answers

What is the potential impact of administering an anesthetic to an area with high nerve ending density?

It can increase the likelihood of incomplete anesthesia. Signup and view all the answers

Which factor would least likely contribute to the success of an anesthetic?

The ambient temperature during the procedure. Signup and view all the answers

Which anesthetic agent is characterized by having a maximum dose of 5 mg/kg when combined with epinephrine?

Bupivacaine Signup and view all the answers

What role does the size of the area to be anesthetized play in the effectiveness of anesthesia?

Larger areas typically require a higher initial dosage. Signup and view all the answers

In which scenario would the use of a fenestrated drape be most appropriate?

During a surgical procedure where an incision will be made. Signup and view all the answers

What is the type of wound healing that occurs when sutures or adhesives are used to close the wound at the time of injury?

Primary Intention Signup and view all the answers

Which phase of wound healing is primarily characterized by the formation of fibrous tissue and scar formation?

Maturation Phase Signup and view all the answers

During which type of wound healing is an attempt made to close a wound a few days after the initial injury?

Delayed Primary Closure Signup and view all the answers

What is the primary goal of laceration repair in clinical practice?

Achieving hemostasis and preventing infection Signup and view all the answers

Which anatomical layer contains the primary components such as collagen and elastic fibers responsible for skin resilience?

Dermis Signup and view all the answers

Which type of suture material is preferred when an absorbable option is needed for deeper tissue layers?

Catgut Signup and view all the answers

In the evaluation of a wound, which factor is least likely to be considered when opting for immediate laceration closure?

Patient history of antibiotics Signup and view all the answers

What is the important consideration when performing a running suture technique?

It enhances the tensile strength of the closure Signup and view all the answers

What common factor can hinder the healing process of a wound and raise infection risks?

Significant tissue loss Signup and view all the answers

What key aspect should be documented after performing a laceration repair?

Details of anesthetic administration and technique used Signup and view all the answers

What is the maximum time allowed for suturing a laceration that is not located on the face?

24 hours Signup and view all the answers

Which wound factor is associated with potential contamination and poor healing outcomes?

Tissue ischemia Signup and view all the answers

What symptom is NOT typically associated with an acute laceration injury?

Fever Signup and view all the answers

In assessing the mechanism of injury, which type of injury is characterized by a deep penetrating wound potentially introduced by an object?

Puncture Signup and view all the answers

Which of the following imaging methods is most effective for locating objects with densities similar to soft tissue?

CT scan Signup and view all the answers

Which of these is NOT a common factor that could impair wound healing?

Tetanus immunization history Signup and view all the answers

What consideration is crucial before administering an anesthetic during physical examination?

Assessing the wound for foreign bodies Signup and view all the answers

What aspect of closure techniques is least favorable when using staples for laceration repair?

Low tensile strength Signup and view all the answers

In a functional examination of an injured area, what is a key focus area?

Mobility of joints Signup and view all the answers

Which repair technique is most suitable for wound areas at high risk for infection?

Rapid meticulous sutures Signup and view all the answers

What type of anesthesia is suggested for in-depth examination and repair of most wounds?

Local anesthesia Signup and view all the answers

Which patient factor is least likely to enhance the success of anesthetic treatment during surgical procedures?

Age Signup and view all the answers

Which anesthetic agent has the shortest onset time without the addition of epinephrine?

Lidocaine Signup and view all the answers

What is the maximum dosage of Bupivacaine allowed without epinephrine?

3 mg/kg Signup and view all the answers

What factor does NOT significantly alter the duration of an anesthetic’s effect?

Patient's pain threshold Signup and view all the answers

What is primarily preserved during the repair of deeper lacerations?

Function of underlying muscle and tissue Signup and view all the answers

Which phase of wound healing is identified by granulation tissue formation?

Proliferative Phase Signup and view all the answers

What is the main advantage of delayed primary closure in wound management?

Minimizes the likelihood of infection Signup and view all the answers

Which wound healing type is appropriate when an immediate closure is not feasible due to contamination?

Secondary Intention Signup and view all the answers

In the context of suturing, which suture material is considered nonabsorbable?

Silk Signup and view all the answers

Which element is essential to assess during the initial evaluation of a laceration?

Mechanism of injury Signup and view all the answers

During laceration repair, what is the primary purpose of using petrolatum gauze in delayed primary closure?

To prevent infection and help with re-approximation Signup and view all the answers

Which factor should NOT be considered when implementing wound care post-procedurally?

Duration of the procedure Signup and view all the answers

What is the effect of placing nonabsorbable sutures deep in a contaminated wound?

Increases chance of infection Signup and view all the answers

What is the primary goal of hemostasis during laceration repair?

To control bleeding effectively Signup and view all the answers

Which symptom is least likely to be reported by a patient during the initial history of a laceration?

Nausea Signup and view all the answers

What factor related to the wound can contribute to impaired healing and increase infection risk?

Tissue Ischemia Signup and view all the answers

Which repair technique is characterized by meticulous application and low risk of dehiscence?

Sutures Signup and view all the answers

In which circumstance is plain radiography indicated for wound evaluation?

When metal foreign body is suspected Signup and view all the answers

Which of the following factors is least relevant when assessing the mechanism of injury?

Patient's financial status Signup and view all the answers

What is a critical consideration during the physical examination of a patient with a laceration?

Exploration for foreign bodies Signup and view all the answers

Which of these materials is known to have the lowest tensile strength when used for wound repair?

Tapes Signup and view all the answers

Which type of imaging is least likely to be useful for locating soft tissue foreign bodies?

Plain radiographs Signup and view all the answers

Which condition related to the wound influences the choice of closure method?

Tissue contamination Signup and view all the answers

Which aspect of previous wound history is critical to document for future treatment implications?

Presence of hypertrophic scars Signup and view all the answers

Study Notes

Skin Anatomy

The epidermis is the outermost layer of the skin and has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum (deep to superficial).
The dermis contains collagen, elastic fibers, nerve fibers, blood vessels, sweat and sebaceous glands, and hair follicles.
The subcutaneous tissue contains blood vessels, nerves, lymph, and loose connective tissue.

Phases of Healing

Hemostasis: the body stops bleeding by constricting blood vessels and forming a clot.
Inflammatory Phase: involves inflammation, white blood cells clearing out debris, and the beginning of tissue repair.
Proliferative Phase: new blood vessels develop, and granulation tissue fills the wound.
Maturation Phase: collagen fibers remodel, and the scar strengthens, and gains tensile strength.

Types of Wound Healing

Primary Intention: Wounds are closed at the time of surgery.
Secondary Intention: Wounds are left open to heal by granulation, which occurs in a contaminated wound.
Tertiary Intention: Wounds are left open for a few days before being closed with sutures.

Patient Evaluation

History should include the mechanism of injury, wound location, and any factors that could affect the wound's healing process.
Examine the patient's neurovascular status, muscle function, any foreign bodies, and evaluate the patient's pain.
Wound imaging (radiographs, CT, MRI, US) can be used to identify and locate foreign bodies.

Laceration Repair Techniques

Sutures: Time-honored method, requiring time and precision, provides excellent tensile strength, and can be difficult to remove.
Staples: Fast, low tissue reactivity, less meticulous, good for high-tension wounds, and removal can interfere with wound healing and some imaging.
Tissue Adhesives: Fast, comfortable, little risk of infection, less expensive, and not appropriate for high-tension wounds.
Hair Apposition: Fast, comfortable, easy to apply, less expensive, and only good for simple lacerations.

Supplies for Laceration Repair:

Ruler in centimeters
Irrigation device and sterile saline
Anesthetic
1 to 10ml syringe
27g ¼ in. needle; 18g needle
Surgical sterile preparation
Sterile drapes; fenestrated drape
4x4 gauze sponges
Sterile pack containing: Needle Holder/Driver, Iris and suture scissors, Hemostat, Adson Forceps
No. 15 blade scalpel
Suture materials
Gloves/Sterile gloves
Face shield

Anesthesia

Topical, local, and regional anesthesia can be used for wound repair.
Factors that affect anesthesia effectiveness:
- Blood supply
- Size of the area to be anesthetized
- Location of the wound
- Patient factors (e.g., infection, anxiety, chronic disease)

Skin Anatomy

The epidermis has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum
The dermis contains collagen, elastic fibers, nerve fibers, blood vessels, sweat and sebaceous glands, and hair follicles
Subcutaneous tissue consists of blood vessels, nerves, lymph, and loose connective tissue

Phases of Healing

Hemostasis: stops bleeding
Inflammatory/Substrate Phase: Inflammation and cell migration; lasts 1-3 days
Proliferative Phase: granulation formation and epithelialization; lasts 3-21 days
Maturation Phase: remodeling and scar formation; occurs over months

Types of Wound Healing

Primary intention: wound edges are closed with sutures, tapes, or adhesives at the time of injury
Secondary intention: wound is left open to heal by granulation
Delayed Primary Closure: wound is left open for a few days before being closed primarily

Patient Evaluation for Lacerations

History should include: mechanism of injury (sharp, blunt, bite/puncture, foreign body), dirty vs. clean, time since injury, contributing factors (intentional/unintentional, assault, etc.), symptoms (pain, swelling, paresthesia, muscle weakness), functional details (occupation, handedness), allergies, medications, tetanus immunization history, factors impairing healing or increasing infection risk, and previous scar formation
Physical examination should include: calm, cooperative, well-positioned patient, optimal lighting, minimal bleeding, functional examination (neurovascular, muscular, tendons, joints), exploration for foreign bodies

Diagnostic Evaluation for Lacerations

Wound imaging to identify potential foreign bodies, especially metal, bone, teeth, and certain plastics
Types of imaging include: plain radiographs, CT, MRI, and ultrasound

Laceration Repair Techniques

Sutures: Time-honored technique, provides the most tensile strength, but requires anesthesia and needle stick
Staples: Rapid, low tissue reactivity, but may be less meticulous and can interfere with some types of imaging
Tissue adhesives: Rapid, comfortable, low cost, but have lower tensile strength, cannot submerge in water, and may only be suitable for hairless areas
Hair tapes: Least reactive, cost-effective, require no needle stick, but come with the lowest tensile strength and are primarily suitable for the scalp

Supplies for Laceration Repair

Ruler in centimeters
Irrigation device and sterile saline
Anesthetic agent
Syringe
Needles (27g ¼ in. and 18g)
Sterile preparation
Sterile drapes
4x4 gauze sponges
Sterile pack containing: needle holder/driver, iris and suture scissors, hemostat, adson forceps
No. 15 blade scalpel
Suture material
Gloves/sterile gloves
Face shield

Anesthesia for Laceration Repair

Most lacerations require anesthesia for examination, irrigation, and repair
Topical, local, and regional anesthesia are used
Anesthetic effectiveness is impacted by factors such as blood supply, area size, nerve ending density, infection, anxiety, diabetes, peripheral vascular disease and obesity

Skin Anatomy

The epidermis is composed of five layers with the stratum basale being the deepest and stratum corneum being the most superficial layer.
The dermis is composed of collagen, elastic fibers, nerves, blood vessels, sweat and sebaceous glands, and hair follicles.
The subcutaneous tissue layer contains blood vessels, nerves, lymph, and loose connective tissue.

Phases of Wound Healing

Hemostasis involves the control of bleeding.
The inflammatory phase begins immediately after injury.
The proliferative phase is characterized by collagen deposition.
The maturation phase is characterized by scar formation and remodeling.

Types of Wound Healing

Primary intention involves wound closure using sutures, tapes, or adhesives at the time of injury.
Secondary intention involves allowing the wound to heal on its own.
Delayed primary closure involves waiting to close a wound for 3-5 days to reduce the risk of infection.

Patient Evaluation

Initial History:
- The mechanism of injury should be clarified, including whether it was sharp, blunt, a bite/puncture, or foreign body.
- The wound should be classified as clean or dirty
- The time since injury is essential for decision making. This includes a 12-hour time limit for sutures and 24 hours for facial lacerations.
- Underlying factors influencing the injury such as intentionality, occupation, and assault should be known.
- Any preexisting symptoms should be noted.
- The patient's occupation and handedness should be documented to understand the impact on function.
- Allergies to anesthetics, antibiotics, latex, etc. should be documented.
- Medication details should be noted.
- Tetanus immunization history is crucial.
- Potential factors that may impair healing or increase infection risk should be considered. These include patient factors like immunosuppression, tissue ischemia, and poor wound healing as well as wound factors like crush injuries, tissue loss, contamination, foreign bodies, and peripheral location.
- Previous scar formation history is relevant for understanding the possibility of hypertrophic scars or keloids.
Physical Exam:
- The patient should be calm, cooperative, and appropriately positioned.
- Optimal lighting and magnification are required for assessment.
- Limited or controlled residual bleeding is expected; a tourniquet or epinephrine-containing anesthetic can be employed for this purpose.
- A functional examination involving neurovascular, muscular, tendons, and joints is conducted before administering the anesthetic.

Diagnostic Evaluation

Wound imaging may be necessary if foreign bodies are suspected.
- Plain radiographs can identify metal, bone, teeth, pencil graphite, certain plastics, glass, gravel, sand, fish bones, some painted wood, most aluminum.
- CT and MRI are useful for objects with densities similar to soft tissue.
- US can be useful, especially for wooden foreign bodies.

Laceration Repair Techniques & Materials

Repair Techniques:
- Sutures are time-honored, meticulous, and provide tensile strength.
- Staples offer a rapid, low-tissue reactivity, and low-cost option.
- Tissue adhesives offer rapid comfort, no removal, low cost, and a low risk of needle stick.
- Hair tapes are least reactive, simple, cost-effective, and offer rapid comfort with no need for needles.
Supplies:
- A ruler in centimeters is essential.
- Irrigation devices and sterile saline are crucial for wound care.
- Appropriate anesthetic is required.
- Syringes (1 to 10 ml) and needles (27g ¼ in. and 18g) are needed for administration.
- Surgical sterile preparation is important.
- Sterile drapes and a fenestrated drape are needed to protect the sterile field.
- 4x4 gauze sponges are needed for absorption.
- A sterile pack containing needle holder/driver, iris and suture scissors, hemostat, and Adson forceps are required.
- A No. 15 blade scalpel is needed for cutting sutures.
- Appropriate suture material is chosen depending on the wound.
- Gloves/Sterile gloves are essential for maintaining sterility.
- A face shield is helpful to protect the clinician.

Anesthesia

Most wounds require anesthesia for examination, irrigation, and repair.
Different types of anesthetic include topical, local, and regional.
Important factors influencing the effect of anesthetic include blood supply, size of the area being anesthetized, location of the wound, and patient factors such as infection, anxiety, and chronic disease.

Skin Anatomy

The epidermis has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.
The dermis contains collagen, elastic fibers, nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles.
The subcutaneous tissue contains blood vessels, nerves, lymph, and loose connective tissue.

Phases of Healing

Hemostasis: The initial phase where bleeding is stopped.
Substrate/Inflammatory Phase: The inflammatory response occurs with redness, swelling, pain, and heat.
Proliferative Phase: New tissue is formed, including granulation tissue.
Maturation Phase: Remodeling of the new tissue occurs.

Types of Wound Healing

Primary Intention: Wound closure with sutures, tapes, or adhesives.
Secondary Intention: Wound healing by granulation without closure.
Delayed Primary Closure: Healing by tertiary intention where the wound is intentionally left open, but then closed after a few days.

Patient Evaluation - History

Mechanism of injury: Determine the type of force (sharp, blunt, bite/puncture, foreign body) and if it was clean or dirty.
Time since injury: Ideally, sutures should be placed within 12 hours, but facial lacerations ideally within 24 hours.
Patient factors: Assess for allergies, medications, tetanus immunization status, immunosuppression, tissue ischemia, previous scar formation, and other factors that could impact healing or increase risk for infection.
Symptoms: Assess for pain, swelling, tingling, numbness, or muscle weakness.

Patient Evaluation - Physical Examination

General: Ensure the patient is calm, cooperative, and positioned safely.
Lighting & Magnification: Have adequate lighting for clear visualization.
Bleeding: The patient should have minimal or no residual bleeding after applying pressure or placing a tourniquet.
Functional Examination: Before anesthetizing, evaluate the injured area for neurovascular, muscular, tendon, and joint function.
Foreign Bodies: Carefully and thoroughly explore the wound for foreign objects (e.g., glass, metal, wood).

Diagnostic Evaluation

Radiography: Order plain radiographs to detect foreign bodies like metal, bone, teeth, pencil graphite, some plastics, glass, gravel, sand, fish bones, painted wood, and most aluminum.
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): Use these for identifying and locating foreign bodies that have similar densities to soft tissue.
Ultrasound (US): Useful for detecting foreign bodies, particularly wood.

Laceration Repair Techniques and Materials

Sutures: The gold standard for wound closure.
Staples: A rapid, less meticulous option for closing tissue, but do not require sutures.
Tissue Adhesives: A rapid, comfort-based option for closure, with low infection risks.
Hair Apposition: Used in certain cases on scalp lacerations, where hair alignment is used to close the wound.

Supplies

Assessment Tools: Ruler, a sterile irrigation device, and saline.
Anesthesia: Topical, local, or regional anesthetic based on need.
Administration: Syringe, 27g ¼ inch needle, and 18g needle.
Sterile Preparation: Sterile gloves, gowns, and drapes.
Gauze Sponges: 4x4 gauze sponges for cleaning and hemostasis.
Wound Closure Instruments: Needle holder/driver, iris & suture scissors, hemostats, adson forceps, and a No. 15 blade scalpel.
Sutures: Select the appropriate suture based on the type of wound and desired healing.
Safety Equipment: Eye protection (face shield), and gloves.

Anesthesia

Most wounds require anesthesia for examination, irrigation, and repair.
Types: Topical, local, and regional.
Factors Influencing Effectiveness: Blood supply, size of the area, location of the wound, infection, anxiety, chronic disease, and patient factors.

Anesthetic Agents

Amides (with and without epinephrine): Bupivacaine (120-240 min duration without epinephrine, 2-10 mg/kg maximum dose) and Lidocaine (30-120 min duration without epinephrine, 24 hours old), are common anesthetic agents.

Skin Anatomy

The epidermis is the outermost layer of skin and has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.
The dermis is underneath the epidermis and contains collagen, elastic fibers, nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles.
The subcutaneous tissue is the deepest layer and contains blood vessels, nerves, lymph, and loose connective tissue.

Phases of Healing

Hemostasis is the first phase of wound healing, stopping the bleeding.
The substrate/inflammatory phase is the second phase, where inflammatory cells are recruited to the wound.
The proliferative phase is the third phase, and a scar develops in the wound.
The maturation phase is the last phase, and the scar is remodeled and strengthened.

Types of Wound Healing

Primary intention is wound closure with sutures, tapes, or adhesives at the time of injury.
Secondary intention wound healing means no attempt to close the wound, and it heals on its own.
Delayed primary closure is where the wound would benefit from closure but is delayed to avoid infection.

Patient Evaluation

Laceration repair aims to achieve hemostasis, prevent infection, preserve function, restore appearance, and minimize discomfort.
Initial history should include mechanism of injury, cleanliness, time since injury, causative factors, symptoms, function, allergies, medications, tetanus history, and factors that could impair healing.
Physical examination should be performed on a calm, cooperative, and appropriately positioned patient with optimal lighting and magnification, ensuring minimal bleeding.

Diagnostic Evaluation

Imaging may be necessary if a foreign body is suspected.
Plain radiographs can identify metals, bone, teeth, and some plastics.
CT, MRI, and US are helpful in identifying objects with soft tissue densities.

Repair Techniques

Sutures are a time-honored method, meticulous, offer tensile strength, and have a low risk of dehiscence but require removal, anesthesia, and needle sticks.
Staples are rapid, low tissue reactivity, and cost-effective but require expertise in application and removal.
Tissue adhesives are quick, comfortable, low cost, and minimize needle sticks but have lower tensile strength, cannot be submerged in water, and contain toxic adjuncts.
Hair tapes are the least reactive, simple, rapid, comfortable, and minimize needle sticks but only for scalp lacerations, limited tensile strength, cannot be submerged in water, and cannot be used on hairless areas.

Supplies for Laceration Repair

Necessary supplies include: ruler, irrigation device and saline, anesthetic, syringes, needles, surgical preparation, drapes, gauze sponges, sterile pack (needle holder, iris and suture scissors, hemostat, adson forceps), scalpel, sutures, gloves, and face shield.

Anesthesia for Laceration Repair

Topical, local, and regional anesthetics are used.
Anesthetic effects are influenced by blood supply, area size, nerve ending size and density, patient factors such as infection, anxiety, and chronic disease (diabetes, peripheral vascular disease, obesity).

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Test your knowledge on skin anatomy and the phases of wound healing. This quiz covers the structure of the skin, the healing process, and different types of wound healing. Enhance your understanding of this essential topic in healthcare and biology.