Dr. Victor Zielinski
Resources
Clinical
Aboriginal Health
SurgeryPlastic Surgery - The face & eyes
Suturing
Table of Contents |
Most of us at some time or other will need to suture a wound. This may be due to an accident or one that we create while removing a lesion. It is important to do it well. Here are some guidelines to have in mind.
Placing the Scar
i. Use of natural lines the scar should be placed in the line of a wrinkle or at least parallel to it, so it will look like another wrinkle. ii.Consider the direction of the scar, run it parallel to an expression line iii.Place the scar where it will not be seen e.g. inside the hairlineSkin closure
Sutures
- there are many types available. They differ in composition. Nonabsorbable: nylon, polypropylene, Absorbable: catgut, polyglycolic acid, polyglyconate. There are a large number of different needle sizes and types. For skin you must use a cutting needle and 19 or 24mm diameter is a good choice.Clips
- these are getting more acceptance but are really only useful for large incisions and when time is an important consideration. They are generally too expensive in General Practice.Tapes
- these are made in various width and colours. My preference is for 1/4 inch flesh toned type. These can be cut in half length so as to make them easier to handle and more cost effective. These are the least conspicuous and are easy to apply. Anything smaller or wider is less accurate. Often a few strips of tape will hold the epithelium together provided that the deeper tissues are not under tension.Suture Materials
Silk - NOT recommended
as it causes too much tissue reaction.Nylon
- this should be the main material used and the sizes of 4/0 or 3/0 are ideal. The reason for the finer sutures is that they will break before you can apply too much tension to the wound edges.Polypropylene
(Surgilene, Prolene) Best for subcuticular and continuous type suturing. These are the easiest to pull out.Polyglycolic Acid (Dexon II)
synthetic absorbable for deeper layers. Absorbed by hydrolysis and in general not recommended in the skin. Commonly used in children as a subcuticular suture. The newer Dexon II is also easier to tie than it's predecessor. Catgut - dissolves in an unpredictable time frame, excites tissue reaction during its destruction.Instruments
Forceps
- toothed fine AdsonísNeedle holder
- use a small one for fine suturesScissors
- for cutting sutures as well as for dissecting tissuesScalpel blade
- No.15 or No.10 Handle for scalpelAnaesthetic
Xylocaine with Adrenaline 1:100,000 is a good safe general purpose agent but must be careful in cases where cardiac problems exist and must not use it on fingers, toes. In children EMLA cream for ONE hour over the area will stop the pain but this time delay is not always practical.Excising lesions
General considerations apply and those related to the particular pathology. Must have an adequate margin of excision for a BCC, SCC. Removal of the lesion is the first priority and the ability to close the defect is only the secondary consideration. Send all specimens for pathological examination. This will confirm your diagnosis and determine the margins of clearance. The wound should be closed in layers.Scar problems
Hypertrophic
- red raised scar that will eventually subside, confined to the area of injuryKeloid
- red raised scar, exceeds the boundaries of the injury, progressive. It takes many years to subside.Dressings
Light and absorbent material should be used. The other function of dressings is to splint the part to give it a rest and allow oedema to be absorbed.Removal of Sutures
On the face about 5-7 days is enough. Scalp, back or limbs minimum of 10 days is advisable. It is also good practice to splint the scar with adhesive-strips or sticky tape for a further week. This will give a better cosmetic result.
Return to top of pageThis page was last built on 1/6/98; 12:56:35 AM.
It was originally posted on 10/5/98; 12:16:01 PM.
Webmaster: tlembke@om.com.au.
 |
Index |  |
The Glabellar Flap |
MedicineAu