Suturing
Instead of poking penetrating wounds…
A better way to approach these wounds is as follows:
- Is the patient unstable? If so, you know the penetration caused the problem and the patient belongs in the OR.
- Is there other evidence of deep injury, such as peritonitis with a penetrating abdominal wound? If so, the patient still needs to go to the OR.
- Do a legitimate local wound exploration. This entails making the hole bigger with a knife, and using surgical instruments and your eyes to find the bottom of the tract. Obviously, there are some parts of the body where this cannot be done, such as the face, but they probably don’t need this kind of workup anyway.
Wound care 101…(I’m sorry if this trashes all your foundation knowledge)
- You DO NOT need sterile gloves to stitch a simple laceration ($$ saved)
- Advance the needle through the margin of the wound and sequence injections so that subsequent needles are inserted through previously anaesthetized tissue to reduce the pain of local an aesthetics
- Tap water does wonders to clean your wound…you don’t need any fancy solutions. Both chlorhexidine and povidone iodine have been found to inhibit wound healing, by inhibiting fibroblasts (bad bad for your wound)
- Toothed forceps can be used for picking up and loading needles onto needle holders. You should NEVER do this with your fingers. They AREN’T (as is commonly taught) for grasping the epidermis and dermis.
