Healthcare and Medicine Reference
In-Depth Information
CHAPTER 21
Specials: Suturing and Joint Aspiration
Simon Laing 1 and Chris Hetherington 2
1 City Hospital, Birmingham, UK
2 Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Redditch, UK
Contraindications (unsuitable wounds)
Associated tendinous or bony injury.
OVERVIEW
By the end of this chapter you should be able to:
identify which wounds to suture
Presence of foreign material.
Infected/dirty wound.
describe and identify the equipment needed
Inability to adequately clean/explore wound with facilities/local
describe how to suture
anaesthetic alone.
Irregular edges which are diffi cult to approximate accurately.
know which joints to aspirate
Crush injuries.
describe how to aspirate a joint.
Wounds more than 12 hours since injury.
Other options to suturing
Suturing
Wounds are caused by several mechanisms. A focused history and
examination will assess:
indications for, and contraindications to closure in the emergency
Steristrips (Figure 21.1)
Wounds with well approximated edges which will oppose with
minimal tension (e.g. pretibial skinfl ap).
Unsuitable on hairy areas.
department
the most appropriate method of wound closure.
Need to be kept dry for 7 days.
Skin tissue adhesive/glue (e.g. histoacryl)
Applied only to the upper epidermis.
Wound closure
Primary closure: prompt surgical closure (i.e. immediate suturing
Often used in conjunction with steristrips.
of wound).
Delayed primary closure: closure 3-5 days post injury.
Secondary closure: healing by secondary intention i.e. via forma-
tion of granulation tissue.
Primary closure approximates wounds as accurately as possible.
It aims for the best possible cosmetic result and to assist the healing
process.
Indications (suitable wounds)
Wounds created by sharp metal/knife/glass.
Wounds overlying cosmetically unimportant areas (e.g. scalp
laceration).
Healthy wound edges (good blood supply).
Base of the wound is visible.
No neurovascular defi cit.
No or minimal tissue loss.
Figure 21.1 Steristrips.
 
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