Suturering läpp

Allmänt

Nogsam rengöring samt adekvat kartläggning av skadade strukturer skall utföras nära alla sårskador. Ytliga skrapsår kräver ingen ytterligare kirurgisk behandling.

Det existerar inte ovanligt att små människor kan behöva sutureras (och ibland även undersökas) inom narkos. för att inte adekvat undersöka alternativt åtgärda ett sårskada hos barn/vuxen likt inte medverkar eller accepterar lokalbedövning existerar inte lege artis.

Lokalbedövning

Allmänt

• Utför ständigt distalstatus innan lokalbedövning!

• Behöver ej anläggas sterilt, men rengör alltid översta skiktet för insticket

• Man kan oftast med fördel bedöva direkt i sårkanten

• Aspirera alltid inledningsvis för för att undvika intravasal injektion, deponera därefter lokalbedövningen

Preparatval (vanliga exempel)

Man kan minska smärtan nära lokalbedövning genom att

• Värma bedövningsvätskan till kroppstemperatur

• Buffra med 5 ml natriumbikarbonat 50 mg/ml (spruta in i lokalanestesiflaskan med rosa nål, ml är vilket som får plats. Måste därefter användas inom 24 timmar).

Med alternativt utan adrenalin?

• Lokalanestetika med tillskott av adrenalin minskar blödningen och används ofta inom dessa sammanhang. 

• Traditionellt har man undvikit adrenalin vid ändartärer såsom fingra

  Suturing techniques

  Different types of suture with videos. To learn the basics of suturing prior to trying these out click here.

   

  Simple Interrupted Suture

  • Most simple suture to use and suitable for almost all situations
  • Needle is inserted in one side of the wound and out through the wound itself
  • Suture should extend through the full depth of the dermis
  • Needle re-inserted at the same level in the opposite side of the wound and emerges out of the skin the same distance from the wound edge as the insertion
  • Sutures should be placed approximately mm from the wound edge and 5mm apart (this may vary depending on the size of the wound and location)
  • Use the forceps or a finger to evert the wound edges
  • Try to suture from the more mobile edge to the more fixed edge
  • Knots should be placed on either side of the wound edge and can be used to subtly adjust the edges to lie together

   

  Simple Interrupted Suture

   

  Vertical Mattress Suture

  • Promotes eversion of the wound edges
  • Useful for poorly supported or mobile skin
  • Needle is inserted as per the simple interrupted suture approximately 5mm from the wound edge and brought out the opposite

    Suturing techniques

    Aim of this page

    To demonstrate the basic principles of suturing for the closure of cutaneous surgical wounds.

    The tools

    To obtain the best results, it is important to have good quality instruments that are the correct size for the location and nature of the wounds being closed. The instruments also need to be correctly sterilised and handled carefully.

    The basic suturing kit includes:

    • needle holder
    • fine suture scissors
    • toothed tissue forceps +/- skin hook
    • appropriate suture material

    Suture material

    The two biggest considerations when choosing a suture are the location and tension of the wound. Other important considerations are tensile strength, knot strength, handling, and tissue reactivity. Sutures are divided into two major groups:

    • Absorbable – lose the majority of their tensile strength in less than 60 days. They are generally used for buried sutures and do not require removal.
    • Non-absorbable – maintain the majority of their tensile strength for more than 60 days. They are generally used for skin surface sutures and do require removal postoperatively.

    Suture needles also come in a variety of shapes and sizes. Curved needles are almos

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