Wound Repair

Last updated 03.11.12

 

Index

 

Definition

-  Repair of wounds to skin to achieve

-  Approximation of edges

-  Haemostasis

-  Preseve tissue function

-  Prevent infection

-  Promote rapid healing

-  Restore cosmetic appearance

 

Features

-  Document

-  Meds & allergies

-  Bleeding diathesis

-  Pregnancy, infection, malignancy, DM

-  Neurovascular, ROM, n. a. v. injury

-  Consent: +/- wait until sober if drunk vs family consent

-  Scarring

-  Inevitable if >1/3 dermis involved

-  Remove sutures within 5-7 days to avoid suture insertion scars

-   +/- depending on site

 

Types

-  Perineal repair

 

Equipment

-  +/- magnification

-  Sterile gloves +/- gown/mask/goggles

-  Suture pack

-  Tray for Chlorhexidine + cotton swabs

-  Sterile forceps, scissors, needle holder

-  Suture material

-  Dressing pack

-  20ml syringe

-  Normal Saline

-  Chlorhexadine

-  LA

-  Lidocaine 1% or 2% +/- adrenaline

-  25G+/- needle

-  +/- drawing up needle

-  5ml Syringe

-  Wound dressings

 

Procedure

-  Ensure best light, height & orientation of patient & planned area of operation

-  Wound cleaning & examination

-  Chlorhexadine

-  LA to region

-  Infiltrate through wound edges OR nerve block depending on location

-  Test sensation with sharp to ensure planned sites of suture are anaesthetized

-  Avoid adrenaline with Lidocaine if suturing flaps

-  +/- addition of bicarbonate to injection to lessen pain

-  Prep & drape

-  For forehead lacerations cover ipsilateral eye with tegederm to prevent eye contamination

-  +/- plastic sheet under drape

-  Thorough wound cleaning w saline

-  If bitumen/dirt use scrub brush

-  If grease use topical Bacitracin or Neosporin ointment to dissolve

-  Flush w normal saline via syringe

-   Strong Chlorhexadine solutions may be toxic to subcutaneous tissues

-  Remove all foreign material, blood clots, necrotic tissue

-  Debridement

-  Systematic & meticulous process of removing foreingn material, non-essential contaminiated tissue & all non-viable tissue

-  Tissue of questionable viability may be left to be reassessed at a repeat debridement

-  +/- Tourniquet

-  Use artery forcep so that tourniquet is not forgotten

-  Finger cut from glove rolled onto digit to exsanguinate (1hr+/-)

-  Catheter tied over digit (1hr+/-)

-  Esmarch rubber bandage above elbo or knee (45min)

-  Double cuff (Zimmer apparatus etc) (2hrs+/-)

-  Hampers ability to assess viable tissues

-  Careful use in questionable vascular supply

-  +/- Antibiotics

-  NOT routinely required

-  Ointment, PO, IV

-  Usually if contaminated wound (bite), infected wound or repair delayed >8hrs or difficult to debride

-  Dressing

-  Suture Removal

-  Rough guide 5-7 days

-   Longer for back, legs, chest, abdo

-  Possible to remove alt sutures +/- use steristrips

 

Complications

-  Infection, abscess

-  Scarring

-  Dehescience

 

 

 

References

 

Dermatology Research & Practice: Cutaneous Scarring 2009