Healthcare and Medicine Reference
In-Depth Information
Hair shaft
Box 21.1 Equipment for suturing
Ridges
Many hospitals have a suture pack which contains all the
equipment you need - you should familiarise yourself with the
packs available at your hospital.
As a minimum you require:
topical antiseptic (e.g. 2% chlorhexidine in 70% alcohol)
Epidermis
Eccrine gland
wound cleaning agent (normal saline will usually suffi ce)
Dermis
Sebaceous
gland
local anaesthetic (e.g. 1% lidocaine)
sterile drapes
Blood vessels
needle holder, toothed forceps, scissors, gauze, gallipot
sutures.
Subcutaneous
Adipose tissue
Figure 21.2 Anatomy of the skin.
Useful in children (eliminating the need to inject local
anaesthetic).
Needs to be kept dry for 7 days.
Metal clips
These are infrequently used outside of the operating theatre.
Anatomy of the skin
The skin is composed of three histologically distinct layers
(Figure 21.2).
Figure 21.3 Equipment required to suture a wound.
Epidermis —A stratifi ed squamous epithelium with epidermal
ridges.
Step-by-step guide: suturing
Dermis —The dermis is subdivided into papillary and reticular
layers. The papillary layer houses small blood vessels, lymphatics
and nerve cells sets within fi ne collagen and elastic fi bres. It also
contains invaginations of epithelium. The reticular layer consists of
a vascular plexus, lymph and nerve cells embedded in thicker elastic
fi bres and a dense collagen network; it is within this layer that sweat
glands and hair follicles originate.
Give a full explanation to the patient in simple terms and
ensure they consent to the procedure.
Set up your trolley (Box 21.1 and Figure 21.3).
Prepare your trolley as a sterile fi eld. Wear a plastic
disposable apron and sterile gloves, and take alcohol hand
rub with you
Preparation
Position the patient comfortably, with the wound on a secure
Subcutaneous layer/hypodermis —This consists predominantly of
adipose tissue.
1
surface if possible.
Ensure the fi eld is adequately lit, adopt universal precautions,
Suture types
Absorbable sutures, such as vicryl and monocryl, can be used to
close deep layers of dermis and will not require removal.
Non-absorbable sutures, such as nylon and prolene, are frequently
used to close the epidermis and require subsequent removal. Choose
the thickness of the suture material depending on the site being
sutured. As a rough guide:
lips and mouth 6/0
2
administer local anaesthesia and set a sterile fi eld (as mentioned
in previous chapters) (Figure 21.4).
Adequately clean the skin with an appropriate antiseptic solution
3
(e.g. 2% chlorhexidine in 70% alcohol), irrigate the wound
(with sterile saline) to remove foreign material and debride as
appropriate.
Hold the needle holder with your dominant hand.
4
facial 5/0 or 6/0
5
The needle holder should be held in a similar manner to scissors:
hands and limbs 4/0
thumb through one ring, ring fi nger through the other, with
the index and middle fi ngers against the shaft of the holder for
support to provide stability.
scalp 2/0 or 3/0
other sites 2/0 or 3/0.
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