Passing a Suturing OSCE Station

Suture Choice

  • Material choice
    • Deep: absorbable sutures
      • PDS (mono)
      • Vicryl (multi)
      • Monocryl
      • Caprosyn (monofilament)
    • Superficial: monofilament nonabsorbable sutures
      • Nylon
      • Prolene (polypropylene)
  • Suture size
    • Face – 6.0
    • Most places – 4.0 / 5.0
    • Back, foot, thick muscle – 3.0
  • Monofilament versus braided
    • Monofilament less infection risk, less inflammatory reaction
    • Multifilament easier to tie, less risk of slippage

Suture Removal

  1. Face: 3 days
  2. Ear, lip: 4 days
  3. Chest, abdomen, penis: 8 days
  4. Extremeties: 10 days
  5. Foot, back: 12 days
  6. Chronic steroid use, T2DM: 2-3 weeks

Anaesthetic

  • Lignocaine +/- adrenaline
  • Avoid adrenaline in end-arterial circulation sites
  • Handy tips
    • Inject through the wound edge
    • Use an insulin needle for minimal pain
    • Wait plz before stabbing people
    • A Biers block may be used if there are extensive lacerations on forearms
  • Maximum dosages
    • Lignocaine + adrenaline = 7mg/kg
    • Lignocaine without adrenaline = 3mg/kg
  • Local anaesthetic toxicity
    • Sentinel effects – tinnitus, dizziness, confusion, perioral numbness
    • CNS toxicity – seizures, coma
    • CVS toxicity – Na+ blockade effects (QRS prolongation, dysrhythymias, hypotension, bradycardia)
    • Sodium bicarb, benzos, fluid load, intralipid

Periprocedural considerations

  • Cleaning + sterile technique (but more like clean-contaminated)
  • Decontamination of wound
  • Tetanus vaccination
  • Consider flucloxacillin for wound infections
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