Skin Not Tough Enough?

    NextPrevious

    Skin Not Tough Enough?

    Steri-strip and Suture Combo Technique for Repairing Fragile Skin

     

    Old people.  They come with all sorts of problems and complications. Even simple lacerations are more complicated with them. Have you ever encountered a laceration in an elderly patient whose skin was just so fragile and thin that even your suture just tears right through the skin edges? In these situations, you can try to use steri-strips, but these often provide inadequate approximation and closure, especially in higher tension areas. So what’s a savvy ED physician to do in these situations?

     

    Here’s a trick to try next time you encounter one of these. Consider using a combination of steri-strips and sutures to close the wound. You can place steri-strips along the wound edges. Then, you can suture the wound edges through the steri-strips, which will help hold the skin together and prevent tearing. This can be done with simple interrupted sutures or any other method that works for the wound in question. Tie off the knots over the steri-strips as if they weren’t there. Leave the steri-strips in place until there is adequate wound healing, which could even be up to weeks. The sutures should still come out in the usual timeline, whether a few days or a week depending on location of wound. Make sure to counsel the patient on signs of infection as the steri-strips may obscure your view of the wound edges while they are on there.

    SteriSuturesteristrip suture

    This combination technique first appeared in the plastic surgery literature in 2009. It has also been described in the Journal of Emergency Medicine in 2011. Give it a try next time in the ED.

     

    Check out the video and websites below for more info.

     

    Sources

    https://lacerationrepair.com/special-situations/fragilethin-skin-technique/

    https://www.aliem.com/2011/trick-of-trade-steristrip-suture-combo/

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious