The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. 15. Discussed showering, eventual removal of Steri-Strips, activity limitations for next 4 weeks. This 26-year-old man received many cuts and bruises after falling from a 7-story window. 1. One study found the same cosmetic outcomes with adhesive strips vs. tissue adhesive when used to repair facial lacerations.57, Once a wound has been adequately repaired, consideration should be given to the elements of aftercare. If tissue adhesive is misapplied, it should be wiped off quickly with dry gauze. 17. Laceration of upper or lower eyelid skin can be repaired with 6-0 nylon sutures. Inform patient that the procedure is not painful but the patent may feel some pulling of the skin during suture removal. The wound appears improved to the patient. Standard post-procedure care is explained and return precautions are given. Alternatively you can use no touch technique. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Ear trauma often causes a hematoma, and applying a pressure dressing can be difficult. Sutureremoval is determined byhow well the wound has healed and the extent of the surgery. 9. Ventura County Medical CenterFamily Medicine Residency Program, 300 Hillmont Ave, Building 340, Ventura, CA 93003. Safer Patient Handling, Positioning, Transfers and Ambulation, Chapter 6. This action prevents the suture from being left under the skin. Instruct patient to take showers rather than bathe. Remove remaining sutures on incision line if indicated. If there is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade. Place Steri-Strips on remaining areas of each removed suture along incision line. Contact physician for further instructions. Checklist 34 provides the steps for intermittent suture removal. Do not pull the contaminated suture (suture on top of the skin) below the surface of the skin. Keep wound clean and dry for the first 24 hours. Instruct patient to pat dry, and to not scrub or rub the incision. After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. Use tab to navigate through the menu items. Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. Skin closure tapes, also known as adhesive strips, have recently gained popularity. Laceration closure techniques are summarized in Table 1. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. 17. 39 Skin can be repaired using staples; interrupted, mattress, or running sutures, such as. What patient teaching is important in relation to the wound? Clean incision site according to agency policy. Placing a single suture at each margin first ensures good alignment.37. Grasp knotted end with forceps, and in one continuous action pull suture out of the tissue and place removed sutures into the receptacle. Ensure proper body mechanics for yourself and create a comfortable position for the patient. Laceration through the portion of the upper or lower lid medial to the punctum often damages the lacrimal duct or the medial canthal ligament and requires referral to an ophthalmologist or plastic surgeon. Staples are made of stainless steel wire and provide strength for wound closure. Gently pull on the knot to remove the suture. Alternately, the removal of the remaining sutures may be days or weeks later (Perry et al., 2014). If the same physician who placed the sutures removes them during the original procedure's global period, you cannot report the removal separately. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes. Also, surgeons use stitches during operations to tie ends of bleeding blood vessels and to close surgical incisions. Clinical Procedures for Safer Patient Care, Continuous / Blanket Stitch Suture Removal, Creative Commons Attribution 4.0 International License. 8. Snip second suture on the same side. An alternative is to remove all sutures on day 3 and support the closure by then applying wound tape. If concerns are present, question the order and seek advice from the appropriate health care provider. The wound is cleansed a second time, and adhesive strips are applied. Although patients have traditionally been instructed to keep wounds covered and dry for 24 hours, one study found that uncovering wounds for routine bathing within the first 12 hours after closure did not increase the risk of infection.58, A small prospective study showed that traumatic lacerations repaired with sutures had lower rates of infection when antibiotic ointment was applied rather than petroleum jelly. There are no significant studies to guide technique choice. Wound becomes red, painful, with increasing pain, fever, drainage from wound. Cut Steri-Strips so that theyextend 1.5 to 2 inches on each side of incision. Document procedures and findings according to agency policy. Apply clean non-sterile gloves if indicated. Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours after injury. The healthcare provider must assess the wound to determine whether or not to remove the sutures. Clinical Procedures for Safer Patient Care by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. Document procedures and findings according to agency policy. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. They deny fevers or malaise. The lesion was removed in the usual manner by the biopsy method noted above. Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. If using a blade to cut the suture, point the blade away from you and your patient. 14. Steri-Strips applied. Ventura County Medical CenterFamily Medicine Residency Program, 300 Hillmont Ave, Building 340, Ventura, CA 93003. 13. Wound infection: If signs of infection begin, such as redness, increasing pain, swelling, and fever, contact a doctor immediately. Keloids occur when the body overreacts when forming a scar. The body of the needle is the portion that is grasped by the needle holder during the procedure. Confirm prescribers orders, and explain procedure to patient. Sutures may be absorbent (dissolvable) or non-absorbent (must be removed). An article on wound care was previously published in American Family Physician.2, When a patient presents with a laceration, the physician should obtain a history, including tetanus vaccination status, allergies, and time and mechanism of injury, and then assess wound size, shape, and location.3 If active bleeding persists after application of direct pressure, hemostasis should be obtained using hemostat, ligation, or sutures before further evaluation. The search included relevant POEMs, Cochrane reviews, diagnostic test data, and a custom PubMed search. 10. To remove intermittent sutures, hold scissors / blade in dominant hand and forceps in non-dominant hand. At the time of suture removal, the wound has only regained about 5%-10% of its strength. They have been able to manage dressing changes without difficulty at home. Remove remaining staples, followed by applying Steri-Strips along the incision line. This prevents the transmission of microorganisms. Author disclosure: No relevant financial affiliation. This scarring extends beyond the original wound and tends to be darker than the normal skin. Allow small breaks during removal of sutures. The doctor applies pressure to the handle, which bends the staple, causing it to straighten the ends of the staple so that it can easily be removed from the skin. Report findings to the primary healthcare provider for additional treatment and assessments. The redness and drainage from the wound is decreasing. Explain process to patient and offer analgesia, bathroom, etc. Therefore, the first skin suture should be placed at this border. Tetanus prophylaxis should be provided if indicated. Care and maintenance includes frequent dressing changes and attention to the peri-wound skin, which is at risk for breakdown in the presence of ++ moisture. Tissue adhesive should not be applied to misaligned wound edges. Key words were skin laceration, skin repair, local anesthesia, sterile technique, sterile gloves, and wound irrigation. PROCEDURE 130 Suture and Staple Removal Brian D. Schaad PURPOSE: Sutures and staples are placed to approximate tissues that have been separated. Using the principles of sterile technique,place Steri-Strips on location of every removed staple along incision line. Keloids, on the other hand, rarely go away. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. What factors increase risk of delayed wound healing? This allows for dexterity with suture removal. When using interactive dressings such as film dressings, hydrocolloid dressings, or foam dressings, they should be changed according to package recommendations, which is anywhere from three to seven days or when fluid accumulation separates the dressing from the surrounding skin.62, Patients with contaminated or high-risk (e.g., deep puncture) wounds who have not had a tetanus booster for more than five years should receive a tetanus vaccine. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. Scissors and forceps may be disposed of or sent for sterilization. Instruct patient about the importance of not straining during defecation, and the importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Want to create or adapt OER like this? Any suspicion of injury involving tendon, nerve, muscle, vessels, bone, or the nail bed warrants immediate referral to a hand surgeon. Staples are used on scalp lacerations and commonly used to close surgical wounds. Non-absorbent sutures are usually removed within 7 to 14 days. https://www.youtube.com/watch?v=-ZWUgKiBxfk, https://lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/. Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Remove dressing and inspect the wound using non-sterile gloves. Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed. 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