7/5/2016 1 Wound Management and Basic Suturing Techniques 10 July 2016 Douglas Winstanley, DO FAAD FACMS West Michigan Dermatology Grand Rapids MI Hugh Greenway’s 33 nd Annual Cutaneous Anatomy and Surgery Course La Jolla, CA Disclosures • No relevant disclosures
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Wound Management and Basic Suturing Techniques€¦ · • Basic Suturing technique • Good control of wound edges • Time consuming • Track marks Diagram from Surgery of the
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7/5/2016
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Wound Management and Basic Suturing Techniques
10 July 2016Douglas Winstanley, DO FAAD FACMS
West Michigan DermatologyGrand Rapids MI
Hugh Greenway’s 33nd Annual Cutaneous Anatomy and Surgery Course
La Jolla, CA
Disclosures
• No relevant disclosures
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Outline
• Wound Healing– Stages of Healing
• Basic Suturing– Suture review
– Subcutaneous Suturing
– Cutaneous Suturing
• Bandages/Dressings
WOUND HEALING
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Stages of Wound Healing
• Inflammatory
• Proliferative
• Remodeling
Diagram from Surgery of the Skin, Robinson et al. 2nd ed. 2010
Inflammatory Stage (Day 0-5)
• Vascular Response– Platelet Degranulation
•Serotinin, ADP, TA2, Fibrinogen, Fibronectin, VWF VIII
– Clot serves as reservoir for growth factors•TGF α, TGF β, PDGF, EGF
– Remember to enter the skin at a perpendicular angle– Apply your first throw loosely, then secure with
subsequent throws• Take epidermal sutures out sooner rather than
later
DRESSINGS
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Dressings
Diagram from Dermatology, Bolognia et al. 3rd ed. 2012
Dressings
Diagram from Dermatology, Bolognia et al. 3rd ed. 2012
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Dressings: Post Op
• Immobilize wound
• Provide pressure– Hemostasis
• Barrier for microbial contamination
• Protect site
• Maintain moist environment
• Post op instructions
References
• Weitzel, S Taylor R. “Suturing Technique and Other Closure Materials” In Surgery of the Skin: Procedural Dermatology, edited by June Robinson p.189-208.New York, Mosby-Elsevier 2010
• Amarrati C, Goldman G. “Wound Closure Materials and Instruments” In Dermatology, edited by Bolognia J, Jorrizo J, Schaffer J. Ch144. New York, Elsevier 2012.
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Thank you
• Douglas Winstanley, DO FAAD – Private Practice: Grand Rapids, MI