Under this subheading, you’ll find links to some of the more advanced suturing techniques employed for wound closure in emergency medicine practice. I suggest review and mastery of the basic wound closure techniques before attempting these techniques in patient care.
Advanced Suturing
Undermining
Undermining is one of the most underutilized, but superbly useful techniques in high tension laceration repair. Undermining refers to the technique of using sterile scissors to bluntly dissect the dermal layer away from the underlying connective tissue. Through the use of this technique, you can take away some of the connective tissue adhesions which anchor…
Running Percutaneous Sutures
The running percutaneous suturing technique is a nice technique to help you speed up lengthy wound closures. Simple interrupted suturing is still a preferred technique when you want the most meticulous repair, but when dealing with less cosmetic areas, I like this technique as it is involves less knot tying and gets the job done…
Running Subcuticular Suturing
For those of you just here for a nuts and bolts review of the technique, here you go: For those of you who prefer lengthy discourse and want to know why this technique is relevant to them, read on. Running subcuticular sutures are considered to be the “holy grail” of suturing techniques by many. That…
“Dog Ear” Correction
When the lengths of two opposite sides of a wound are uneven, simple closure can distort the adjacent skin, resulting in formation of a “dog ear.” Typically, this can be avoided by placing the suture in the midpoint of each side of the wound and bisecting the wound sequentially. However, the dog ear can be…
Layered Closure
A situation we come across now and then is the through-and-through intra-oral laceration. These can be tricky to repair. The typical mechanism for this injury is a tooth piercing the intra-oral mucosa. Thus, many of these injuries occur around the lips and mouth. This woman fainted and hit her face pretty hard on the ground.…
V-to-Y Conversion Flaps
Occasionally we run into lacerations in the ED involving a large tissue flap avulsion. These are usually the injuries that catch the eyes of nurses and staff, if for nothing else but for the gore factor. Here’s one I treated just a few months ago: A large, V-shaped laceration on the forearm of a carpenter. The large, V-shaped…
Locked Horizontal Mattress Suture
In this variation on the traditional horizontal mattress suture, the suture end attached to the needle is passed underneath the loop on the contralateral side, such that the suture material traverses the wound after it is tied. The suture crossing the wound can aid in apposition of the wound edges, while maintaining the traditional advantages…
The Running Horizontal Mattress Suture
If you like the horizontal mattress suture but can’t imagine taking the time to apply it over and over again for a longer wound, consider this variation. Running the suture, as outlined in the video above, increases efficiency of placement for longer wounds. It can be used as an initial layer for a longer, higher-tension…
The Inverting Horizontal Mattress Suture
While inversion of a wound is generally not a goal of wound closure, there are some situations where inversion may be a desired effect. A variation on the horizontal mattress suture is a simple way to create this effect, as described in the video above. An example of this is when trying to re-create a…
The Shorthand Vertical Mattress Suture
Fans of the vertical mattress suture, consider this relatively straightforward modification of the technique: shorthand it. You were probably taught in medical school, as I was, that the vertical mattress suture typically follows a far-far then a near-near pattern of suture placement. But this doesn’t necessarily have to be the rule. Since the suture material…
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Would you suggest starting with a free platform
like WordPress or go for a paid option? There are so many options out there that I’m completely overwhelmed ..
Any tips? Thanks!
I think your best bet starting out is to use wordpress or another similar site. If you have no coding or web design knowledge, like your truly, you want to be able to focus on great content and let the other stuff be as simple as possible. Good luck!
Thanks alot