Rural Emergency Medicine

Suturing, one of the fundamental skills of a medical practitioner has been around since the time of the Ancient Egyptians. Originally used by the Egyptians for burial preparations, the art of suturing has gone through several renditions throughout the course of history. Yet it still remains one of the chief ways of allowing us to manipulate the body to help others and achieve wound closure.

This series of posts aim to provide a simple guide to the art of suturing. Covering common suture techniques, knot tying, surgical instrumentation, suture material and suture selection. Importantly, it will also cover some other aspects of medicine which are vital to understand to achieve optimal suture results:
◘ Anatomy
◘ Principles of wound care
◘ Anaesthesia

I’ve provided a collection of resources so that people can select those items which are most beneficial to their learning style. Look out for resources as they are added under the sections below.

The presentation below is an overview of the material covered throughout this series.

Wound Assessment

History  and examination are the building blocks of wound assessment, and ultimate influence what you end up doing. Some important steps are highlighted below.
◘ Mechanism of injury
◘ How old is the injury
◘ Where is the injury, how big and how deep
◘ Examine for foreign bodies and/or contamination
◘ Assess neurovascular status and any search for any deep tissue issue injuries (e.g. tendons)
◘ Need for tetanus prophylaxis
◘ Identify risk factors that may effect wound healing
This is by no means a complete list of questions you should ask when a patient presents with an injury. The normal components of a standard medical history (e.g. allergies) are also an important component of your treatment strategy. 

Anaesthesia & Preparation

◘ Before you close the wound
◘ Anaesthetics for Wound Management
◘ Optimising Local Anaesthetic Administration
◘ Digital Ring Block
◘ Biers Block

Suture Techniques

◘ An overview of Suturing Techniques
◘ Simple interrupted suturing
◘ Vertical Mattress
◘ Continuous Subcuticular
◘ Horizontal Mattress

Knot Tying

Grog's Surgical Knots
Basic Square Knot (Boston University)
Two Hand Tie (Boston University)
One Hand Tie (Boston University)
Instrument Tie (Boston University)

Other Management Options

◘ Staples
◘ Glue
◘ Steristrips

Take your Basic Surgical Skills a step further

There are lots of different resources out there to help further refine your skills.
Closing the Gap
Different DIY suture models

References & Resources

  1. 1. Basic Laceration Repair, NEJM (2006)
  2. 2. Stitch Up by Martin Clifton

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