1 / 49

Trauma Service Conference Suturing Technique

Trauma Service Conference Suturing Technique. 陳昭文 醫師 高雄醫學大學附設醫院外傷科. 基本傷口縫合技巧. KNOW HOW/WHEN/WHY? 傷口癒合 傷口準備 傷口縫合. Step 1 : 瞭解傷口癒合過程. Wound Healing - A. Inflammatory Phase Immediate to 2-5 days Hemostasis Vasoconstriction Platelet aggregation Thromboplastin makes clot

tovi
Télécharger la présentation

Trauma Service Conference Suturing Technique

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Trauma Service ConferenceSuturing Technique 陳昭文 醫師 高雄醫學大學附設醫院外傷科

  2. 基本傷口縫合技巧 KNOW HOW/WHEN/WHY? 傷口癒合 傷口準備 傷口縫合

  3. Step 1 : 瞭解傷口癒合過程 Trauma Service / KMUH

  4. Wound Healing - A • Inflammatory Phase • Immediate to 2-5 days • Hemostasis • Vasoconstriction • Platelet aggregation • Thromboplastin makes clot • Inflammation • Vasodilation • Phagocytosis Trauma Service / KMUH

  5. Wound Healing - A • Inflammatory Phase • 紅,腫,熱,痛 • 脆弱  完全靠外在力量封閉傷口 • 為避免過度發炎 • 清創徹底 • 移除異物 • 無創傷性縫合技巧 Trauma Service / KMUH

  6. Wound Healing - B • Proliferative Phase • 2 days to 3 weeks • Granulation • Fibroblasts lay bed of collagen • Fills defect and produces new capillaries • Contraction • Wound edges pull together to reduce defect • Epithelialization • Crosses moist surface • Cell travel about 3 cm from point of origin in all directions Trauma Service / KMUH

  7. Wound Healing - B • Proliferative Phase • 傷口張力部份恢復 • 病患本身及傷口狀態之影響 • 營養不良 • 組織缺氧 • 貧血 • 慢性病 Trauma Service / KMUH

  8. Wound Healing - C • Remodeling Phase • 3 weeks to 2 years • New collagen forms which increases tensile strength to wounds • Scar tissue is only 80 percent as strong as original tissue Trauma Service / KMUH

  9. Step 2 : 瞭解如何準備傷口縫合 Trauma Service / KMUH

  10. Skin preparation • Lavage • Quantity is better than quality • Watch out critical areas • Eyes, perineum, peripheral skin… • Adequate drape • Adequate anesthesia Trauma Service / KMUH

  11. Preparation – Debridement • Wound irrigation • Alcoholic Hibitane • Alcohol-Betadine  70% Alcohol • 避免使用於眼周,口內,會陰,或傷口內 • N/S or L/R solution • 移除異物與壞死組織 Trauma Service / KMUH

  12. Trauma Service / KMUH

  13. 局部麻醉劑使用- Xylocaine • Avoid acid pain • Add 1ml NaHCO3 in 20 ml Xylocaine • + Epinephrine ? • 延長藥效, 減緩出血 • 避免用於皮瓣或四肢末端 • 施打麻藥方式 • 由近而遠  病患較易忍受疼痛 • 保持移動  避免血管內注射 Trauma Service / KMUH

  14. Digital Nerve Block Trauma Service / KMUH

  15. Xylocaine (Lidocaine) • Onset 1-5 mins • Duration 30-120mins • Max Dose 4.5mg/kg • 1ml(2%)x1000mg=20mg • 60kgX4.5mg/kg=270mg  13.5ml CNS 過度興奮 頭暈 耳鳴 抽筋 眼振 Cardiopulmonary 低血壓 心肌抑制 呼吸抑制 Trauma Service / KMUH

  16. Risky Area for Epinephrine Use Trauma Service / KMUH

  17. Premedication? • Valium • Is probably the drug of choice • Increase tolerance to local anesthetics • Increase producting sedation and some amnesia • Avoiding use on patients with liver disease • Demeral, Morphine, Fentanyl… Trauma Service / KMUH

  18. Know our Pals - Suture Materials • 可吸收線(Absorbable) • Natural - Catgut • Synthetic – Dexon, Vicryl, PDS • 不可吸收線(Non-absorbable) • Natural - silk • Synthetic – Nylon, Surgilon, Prolene Trauma Service / KMUH

  19. SUTURE SIZE AND DIAMETER Trauma Service / KMUH

  20. Trauma Service / KMUH

  21. Realize our pals – Needle Tip Trauma Service / KMUH

  22. Realize our pals – Needle Curvature Trauma Service / KMUH

  23. Realize our pals – Read the Envelope Trauma Service / KMUH

  24. Selection of Sutures Material 6/0 5/0, 6/0 4/0 3/0, 4/0 4/0, 5/0 4/0 3/0, 4/0 4/0, 5/0 • Eyelid • Face • Oral cavity • Scalp • Lip • Trunk • Limbs • Hands/feet Trauma Service / KMUH

  25. Timing of Sutures Removal 3-5 (days) 3-5 7-8…or dissolve 7-12 3-5 6-12 6-14 7-12 • Eyelid • Face • Oral cavity • Scalp • Lip • Trunk • Limbs • Hands/feet Trauma Service / KMUH

  26. Another Choice… Trauma Service / KMUH

  27. Step 3 : 如何縫合傷口? Trauma Service / KMUH

  28. How to use your instrument? • 持針器夾住離針尖二分之一至三分之一處 • 垂直進針  保持最佳穿透力量 Trauma Service / KMUH

  29. How to use your instrument? 起手式 Trauma Service / KMUH

  30. Method of Skin Suture • Simple interrupted • Good for irregular wounds • Vertical mattress • Good for thick and thin skin • Horizontal mattress • Looks bad early • Half buried • Good for flaps • Continuous intradermal • Cosmetic demand • Simple running • Quick, for linear wounds Trauma Service / KMUH

  31. Simple Suture – Simple Principle • Only one skin layer • the suture should be wider at the bottom • the knot should be tied adequately and cause no blanching Trauma Service / KMUH

  32. Ideal Ratio 1:1 Trauma Service / KMUH

  33. Ideal Dermis Apposition Trauma Service / KMUH

  34. Simple interrupted suture Trauma Service / KMUH

  35. Vertical Mattress Suture Vertical Mattress Suture 適用於邊緣內翻傷口 Trauma Service / KMUH

  36. Vertical Mattress Suture Trauma Service / KMUH

  37. Running “Continuous” Suture Trauma Service / KMUH

  38. Common Error 1 – 跨距不均 Trauma Service / KMUH

  39. Common Error 2 – 皮下死腔 Trauma Service / KMUH

  40. Common Error 3 - 上寬下窄 Trauma Service / KMUH

  41. Distance between Sutures 1-2 (mm) 2-4 3-4 10-15 4-6 6-10 5-8 3-5 2-4 • Eyelid • Face • Nose • Scalp • Forehead • Trunk • Limbs • Volar hand • Dorsal hand Trauma Service / KMUH

  42. Suturing Technique • Removal of dog ears • Some will subside. When removal is necessary there are several methods. Trauma Service / KMUH

  43. Suturing Technique • Triangular edge • Method of insertion of three point suture to prevent strangulation of the tip of a flap Trauma Service / KMUH

  44. Corner Suture Trauma Service / KMUH

  45. Suturing Technique • Atraumatic technique • Avoid crushing with forceps • Avoid sutures and needles unnecessarily large • Avoid bites of tissue unnecessarily large • Avoid strangulation with knots too tight • Avoid drying of tissues Trauma Service / KMUH

  46. Smooth or teethed forceps? • Smooth • Hold knots, tying suture or vessels • Tooth (teethed) • Hold tissue • 無齒鑷子易滑脫,反需更用力,更易造成組織壓傷 Trauma Service / KMUH

  47. Suturing Technique • Suturing sequence • 兩側端點先縫合, 中間調整間距再縫, 可避免”dog ear” • 較難縫合處可先處理對齊 • 重要之地標要優先對齊縫合 Trauma Service / KMUH

  48. Post-procedural Care • 敷料保護 • 滲液吸收 • 局部固定 • 適度壓力 • 避免疤痕 Trauma Service / KMUH

  49. Practice makes perfect! Trauma Service / KMUH

More Related