Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours after injury. Fluffed gauze under a circumferential head wrap can achieve adequate pressure to prevent a hematoma. Place receptacle close to suture line; grasp scissors in dominant hand and forceps in non-dominant hand. They may be placed deep in the tissue and/or superficially to close a wound. 1. Close the handle, then gently move the staple side to side to remove. People may feel a pinch or slight pull. Topical and injectable local anesthetics reduce pain during treatment of lacerations and may be used alone or in combination.2123 Topical anesthetics (eTable A) are particularly useful when treating children. Learn how BCcampus supports open education and how you can access Pressbooks. CLIPS AND/OR SUTURES REMOVAL . Staples are used on scalp lacerations and commonly used to close surgical wounds. 17. 11. All wounds form a scar and will take months to one year to completely heal. Cut under the knot as close as possible to the skin at the distal end of the knot. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 2.5 to 5 cm. Surgical staples are useful for closing many types of wounds. 3. Grasp the knot of the suture with forceps and gently pull up. developed by Rene Anderson and Wendy McKenzie (2018) Thompson Rivers University School of Nursing. PROCEDURE 130 Suture and Staple Removal Brian D. Schaad PURPOSE: Sutures and staples are placed to approximate tissues that have been separated. Staples are made of stainless steel wire and provide strength for wound closure. Contact physician for further instructions. Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing. Passage of the string or suture may be facilitated with the use of a mosquito hemostat. 12. 10. Place sterile gauze close to suture line; grasp scissors in dominant hand and forceps in non-dominant hand. Alternate sutures (every second suture) are typically removed first, and the remaining sutures are removed once adequate approximation of the skin tissue is determined. They deny fevers or malaise. Inspection of incision line reduces the risk of separation of incision during procedure. The wound appears improved to the patient. No swelling. VENTURA COUNTY MEDICAL CENTERFAMILY MEDICINE RESIDENCY PROGRAM. Complications related to suture removal, including wound dehiscence, may occur if wound is not well healed, if the sutures are removed too early, or if excessive force (pressure) is applied to the wound. Cut the suture at the surface of the skin. Suture removal is determined by how well the wound has healed and the extent of the surgery. Do not pull the contaminated suture (suture on top of the skin) through tissue. If there are concerns, question the order and seek advice from the appropriate health care provider. Wound becomes red, painful, with increasing pain, fever, drainage from wound. Disclaimer:Always review and follow your hospital policy regarding this specific skill. Remove every second suture until the end of the incision line. 2021 by Ventura County Medical Center Family Medicine Residency Program. This picture was taken 1 week after his fall. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Cut Steri-Strips so that theyextend 1.5 to 2 inches on each side of incision. Procedure Notes Procedure Name: Laceration Repair Indication: Reduce risk of infection Location: __________________ Pre-Procedure Diagnosis: Laceration Post-Procedure Diagnosis: Repaired Laceration Informed consent was obtained before procedure started. Also, large keloids can be removed, and a graft can be used to close the wound. Latham JL, Martin SN: Infiltrative anesthesia in office practice. Care should be taken to avoid getting tissue adhesive into the wound or accidentally adhering gauze or instruments to the wound. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. This step allows for easy access to required supplies for the procedure. The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. If suture isnt removed, gently pull on suture material to determine the next entry / exit point. 11. If using a blade to cut the suture, point the blade away from you and your patient. Instruct patient to pat dry, and to not scrub or rub the incision. Complications related to suture removal, including wound dehiscence, may occur if wound is not well healed, if the sutures are removed too early, or if excessive force (pressure) is applied to the wound. Forceps are used to remove the loosened suture and pull the thread from the skin. Excessive scarring: All wounds will form a scar, and it will take months for a scar to completely contract and remodel to its permanent form. 1.2 Infection Prevention and Control Practices, 1.4 Additional Precautions and Personal Protective Equipment (PPE), 1.5 Surgical Asepsis and the Principles of Sterile Technique, 1.7 Sterile Procedures and Sterile Attire, 3.6 Assisting a Patient to a Sitting Position and Ambulation, 4.6 Moist to Dry Dressing, and Wound Irrigation and Packing, 6.3 Administering Medications by Mouth and Gastric Tube, 6.4 Administering Medications Rectally and Vaginally, 6.5 Instilling Eye, Ear, and Nose Medications, 7.2 Parenteral Medications and Preparing Medications from Ampules and Vials, 7.3 Intradermal and Subcutaneous Injections, 7.5 Intravenous Medications by Direct IV Route, 7.6 Administering Intermittent Intravenous Medication (Secondary Medication) and Continuous IV Infusions, 7.7 Complications Related to Parenteral Medications and Management of Complications, 8.3 IV Fluids, IV Tubing, and Assessment of an IV System, 8.4 Priming IV Tubing and Changing IV Fluids and Tubing, 8.5 Flushing a Saline Lock and Converting a Saline Lock to a Continuous IV Infusion, 8.6 Converting an IV Infusion to a Saline Lock and Removal of a Peripheral IV, 8.7 Transfusion of Blood and Blood Products, 10.2 Caring for Patients with Tubes and Attachments. This step prevents the transmission of microorganisms. Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection. Consider the purpose and need for cleaning a wound that has been exposed to air for an extended period. This scarring extends beyond the original wound and tends to be darker than the normal skin. Film dressings allow for visualization of the wound to monitor for signs of infection. It also prevents scratching the skin with the sharp staple. Allow small breaks during removal of sutures. Some of your equipment will come in its own sterile package. 1. Syringe 30-60 ml syringe (requires multiple refills) OR. Stapled surgical wound of the left leg of a 46-year-old woman who underwent femoral artery bypass surgery. Only remove remaining sutures if wound is well approximated. Note the entry / exit points of the suture material. Steri-Strips applied. Patient information: See related handout on taking care of healing cuts. All sutures are lost if one suture is cut by mistake or removed for drainage, Can cause skin necrosis and excessive scars, Most effective in everting triangular wound edges in flap repair, Fast and effective in accurate skin edge apposition, Suited for closing clean wounds, such as surgical wounds in the operating room, Effective in accurate skin edge apposition and wound eversion, Should be avoided if cosmetic outcome is important, Used to approximate clean, simple, small lacerations with little tension and without bleeding, Glycolide/lactide polymer (polyglactin 910 [Vicryl]), Deep dermal, muscle, fascia, oral mucosa, genitalia wounds, Mostly used in vascular surgeries; can be used for skin, tendon, and ligaments, depending on the needles, Used for hemostasis in ligation of vessels or for tying over bolsters, Not in a hair-bearing area (unless hair apposition technique is being used), Not under significant tension (or tension relieved with deep absorbable sutures), No chronic condition that might impair wound healing. Alternate sutures (every second suture) are typically removed first, and the remaining sutures are removed once adequate approximation of the skin tissue is determined. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Note: If this is a clean procedure you simply need a clean surface for your supplies. This step allows for easy access to required supplies for the procedure. To remove intermittent sutures, hold scissors in dominant hand and forceps in non-dominant hand. The edges of the eyebrow serve as landmarks, so the eyebrow should not be shaved. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. Staples are faster and more cost-effective than sutures with no difference in complications.40 The hair apposition technique using tissue adhesive has the lowest cost and highest patient satisfaction for scalp repair.41 A video of the hair opposition technique is available at https://lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/. What situations warrant staple / suture removal to be a clean procedure. Individual patient . An appropriate incision was made in the center of the abscess and gross pus was obtained. Explaining the procedure will help prevent anxiety and increase compliance with the procedure. This step allows easy access to required supplies for the procedure. The wound is usually cleaned with sterile water and peroxide. Copyright 2017 by the American Academy of Family Physicians. Document procedures and findings according to agency policy. A rich blood supply to the scalp causes lacerations to bleed significantly. Removal of sutures must be ordered by the primary health care provider (physician or nurse practitioner). Although patients have traditionally been instructed to keep wounds covered and dry for 24 hours, one study found that uncovering wounds for routine bathing within the first 12 hours after closure did not increase the risk of infection.58, A small prospective study showed that traumatic lacerations repaired with sutures had lower rates of infection when antibiotic ointment was applied rather than petroleum jelly. Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Foam dressings are more absorptive but mostly used for chronically draining wounds. eMedicineHealth does not provide medical advice, diagnosis or treatment. Position patient, lower bed to safe height, andensure patient is comfortable and free from pain. An alternative is to remove all sutures on day 3 and support the closure by then applying wound tape. Compared with multilayer repair, single layer repair has similar cosmetic results for facial lacerations32 and is faster and more cost-effective for scalp lacerations.33 Running sutures reportedly have less dehiscence than interrupted sutures in surgical wounds.34 Mattress sutures (Figures 135 and 235 ) are effective for everting wound edges.36,37 Half-buried mattress sutures are useful for everting triangular edges in flap repair (Figure 3). Gently pull on the knot to remove the suture. Using the principles of sterile technique,place Steri-Strips on location of every removed staple along incision line. The use of. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes. 10. There are several textbooks that are good to have in your clinic for easy review before procedures. 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