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
– 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
– 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