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    By sinaiem | urgent care | Comments are Closed | 24 May, 2013 | 0

    Might as well finish the week off with just a bit more about suturing!!!

    Aftercare (what do you tell your patients!!)

    – Ointment (antibiotic for example) and dressing immediately after lac repair: Not much out there evidence wise what I could find indicates doing this

    • Moisture promotes re-epithelialization
    • Xeroform with gauze isn’t a bad idea
    • REMINDER: if u closed the lac with tissue adhesives DO NOT use topical ointments caue they loosen the adhesive

    – Wrap large scalp wounds, small ones can be left open

    – Leave the wound covered for 24 hours after which it can be open to air.

    – Non-absorbable sutures (nylon, prolene etc) can be gently washed with soap and water after 24 hours – recommend the patient continue to place ointment 2 times a day until the sutures are removed (decreases scab formation)

    • While patient’s with non-absorbable sutures can shower recommend they don’t soak the area (like go swimming, take a long bath) until the sutures are removed

    – Absorbable should be kept dry with minimal exposure to water as it will expedite suture breakdown

    Prophylactic Antibiotics

    – Not necessary in healthy patients with non-bite laceration (a very good lac clean out works just fine)

    – Definitely need to be given for animal and human bites, water exposure, open fractures or wounds with exposed tendons/joints (simple hand lacs no good data as of yet, one article recommending a RCT – any takers!)

    •  probably also in those with excessive contamination, immunocompromised or with vascular insufficiency.

    TETANUS—don’t forget to update their tetanus

    Wound Check

    – Most don’t need a wound check except for those with high risk features (high risk patient, high risk wound or don’t seem capable of identifying signs of infection)

    – Reasons to return include fever, redness/swelling around the wound, pus drainage or the stitches open up

    Suture removal– when should they come back or even better go their PCP for suture removal:

    Face – 5 days (eyelids and neck even earlier 3-4 days)

    Scalp 7-14 days (usually 10 works)

    Trunk- 7 days

    Upper Extremities- 7-10 days (hand  more like 10)

    Lower Extremities- 8-10 days  (foot closer to 12 days)

    • Sutures over joints on in the hands should stay in for 10-14 days because of the tension they are under.
    • If you used tissue adhesives let tell your patient to expect it to slough off in 5-10 days
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