Procedural Skills for Medical Students

Skin Stapling, Suturing, and Skin Closure

Objectives:

1.  Learners will be able to describe the different types of suture material and their unique properties as well as various suture needles and their specific applications.

2.  Learners will be able to describe various suturing techniques, indications for their use, and proper preparation of the surgical field for suturing.

3.  Learners will be able to demonstrate proper needle loading onto needle driver, a simple interrupted stitch, and a simple running stitch.

Material to review prior to lab: Video on Basic Laceration Repair (need access to New England Journal of Medicine, available to students through the University of Arizona Health Sciences Library) and Wound Closure Technique, article on Medscape.

Indications:

1.  Suturing – traumatic skin wound needing closure.

2.  Stapling – open wounds on scalp, extremities, or torso with straight, clean edges that are easily approximated

3.  Stapling is an effective alternative for pediatric lacerations.

4.  Stapling indicated for mass casualty or multiple traumas (timely).

Contraindications:

1.  Suturing: if there is an extended interval between injury and repair.

2.  Suturing: consider other factors including patient’s age and state of health, potential for foreign bodies embedded in the wound, associated injuries to underlying structures, and the degree of contamination.

3.  Stapling: Deep wounds, inadequate hemostasis, CT scanning is planned, MRI is planned, or lacerations on face, hands, feet.

Equipment: suture pads, sutures, staples, stapling device, staple remover, needle drivers, and forceps

Instructional Procedure & Endpoints:

  1. Learners will be oriented to trainers and equipment in ASTEC.
  2. ASTEC staff will demonstrate proper technique for suturing and stapling of open wounds.
  3. Learners will verbalize indications and differences for suturing versus stapling of open wounds.
  4. Learners will practice suturing and stapling on suture pads and trainers.
  5. Learners will be required to suture a two-inch length appropriately (as evaluated by ASTEC staff) on suture pads prior to completion of this lab.

References:

Galli, S.K.D. & Constantinides, M. (2011). Wound closure technique. Emedicine Website. Retrieved from: www.emedicine.com/ent/topic35.htm

James, D. (2011). Skin stapling. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care, 3rd Ed (235-237). Philadelphia: Elsevier Mosby.

Reynolds, R.D. (2011). Laceration and incision repair: Suture tying. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care, 3rd Ed (179-183). Philadelphia: Elsevier Mosby.

Thomsen, T.W., Barclay, D.A., & Setnik, G.S. (2006). Basic laceration repair. The New England Journal of Medicine, 355(e18). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMvcm064238#figure=preview.gif

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