Wound Closure and Suture

Background

When done properly wound irrigation and repair can help prevent infection and speed recovery.  Remember that large volumes of low pressure water should be used for irrigation.  The water does not have to be sterile!  The wound is already dirty, so clean water is enough!  The best option is allowing the patient to wash it out in a sink with constantly running water.  Repair can help to reduce the time it takes for the wound to heal, but may increase infection risk.  Healing by secondary intent is ok when you have significant concerns about infection from a dirty wound.  Finally, remember to check if a tetanus shot is needed!

Consent Form

Wound Closure and Suture Consent Form

Equipment List

Nitrile Exam Gloves (1 pair)

Irrigation Fluid:  Access to a sink, or 1 L Normal Saline or Sterile Water (1)

60 ml (or largest available) Syringe (1)

Splash Guard (1) if available

Wash Basin (1)

Kidney Basin (1)

Iris Scissors, Straight (1 pair)

Needle Driver (1 pair)

Toothed Pickup (1)

Suture: Assorted (if specific suture not requested by provider)

• 3-0 Vicryl (1)

• 4-0 Ethilon (1)

Iodine swabs (5)

Alcohol Swabs (4)

Sterile 4x4 gauze (10)

Sterile 2x2 gauze (5)

1% or 2% lidocaine:  If fingers, toes, penis, or nose - then without epinephrine.  Otherwise with epinephrine.   (1 vial)

10 ml syringe (1)

18 gauge 1.5 inch needle (1)

27 gauge 1.5 inch needle (1)

Exam-room sheet (1 sheet) when necessary due to location of area to be sutured.

Chux pads (5)

Petroleum jelly (1 tube)

Dermabond (1 tube)

Steri Strips (3)

Paper medical tape (1 roll)

Coban roll (1)

Band-Aid (1) if area is small enough to be covered by Band-Aid

Procedure Note

WOUND CLOSURE

Wound examined to ensure no foreign bodies.  Wound irrigated with large volume of clean water prior to repair.  Risks and benefits of wound closure discussed with the patient including risk of infection and potential need to remove repair in the future.  Patient indicated understanding and wished to proceed with closure.  Anesthesia achieved with subcutaneous injection of _ ml of _% lidocaine with_ epinephrine.  Wound then closed with _.  Good tissue approximation and hemostasis achieved.  Return precautions discussed.  Patient instructed to return in _ days for removal of suture.