"Looks like a plastics repair"

[tkim]

I got told that a couple time when I was a MS4 in doing my home ED rotation. At the time I was proud of the comment. It hit me a couple years later, when I was supervising an MS4 taking a looong time to sew a lac, I said gently "it doesn't have to be a plastics job", that perhaps it really wasn't a compliment I was getting. Oh well.

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[deleted109597]

Nah. I would rather take a little extra time on someone's face than try and hurry it up. If you know how to do it good, you can always do it fast. If you only know how to do it fast, you probably can't do it very good. Any other part of their body deserves whip stitches.

You never know when you're going to have to suture up your own kids face.

 

[otacon88]

Funny that you mention that, I had a huge hand lac repair that I had to do last month , almost went down to the tendons but all N/V function was intact. My attending came in and looked at it after I finished and was like "Wow maybe plastic surgery is your calling instead of EM!"

 

[southerndoc]

I always take time with faces, and I frequently use deep sutures. It bothers me when I see a lac that can be spread open easily and a PA doesn't place deep sutures. Without them, it increases scarring. I learned this from a plastic surgeon.

 

[Arcan57]

I always take time with faces, and I frequently use deep sutures. It bothers me when I see a lac that can be spread open easily and a PA doesn't place deep sutures. Without them, it increases scarring. I learned this from a plastic surgeon.

I was always told to avoid deeps or try and minimize them as much as possible on the face (except for lips for tears through the muscle) because the deeps cause increased granulation and may make the scarring worse.

 

[xaelia]

My ethos for areas of concerning visibility is to minimize tissue trauma and to do as little as possible to simply approximate the edges. Whatever combination of suture, sterile tape, and tissue adhesive as needed to allow innate healing mechanisms to function optimally.

FWIW, I'm also an absorbable suture on the face guy. Fast-absorbing plain gut or Vicryl Rapide.

 

[medic25]

I always take time with faces, and I frequently use deep sutures. It bothers me when I see a lac that can be spread open easily and a PA doesn't place deep sutures. Without them, it increases scarring. I learned this from a plastic surgeon.

+1 on deep sutures, especially on facial lacerations. It may take a little more time, but the cosmetic result is worth it (at least in the humble opinion of a PA who regularly uses layered closures on the face...).

 

[southerndoc]

I was always told to avoid deeps or try and minimize them as much as possible on the face (except for lips for tears through the muscle) because the deeps cause increased granulation and may make the scarring worse.

Not what I've seen done by the plastics guys and not what I've been taught. I'll see if I can find a reference to it. I think it may be in the 2010 LLSA readings, which I'm being a slacker and haven't caught up on yet.

 

[Groove]

The sad thing is that of all the procedures that I do in the ED, sewing up complicated lacs ranks in the top 5. The problem is that I now dread them because they just take so damn long to meet my personal standards. I actually want it to look like a plastics job after I'm done but who's got time to do this in the ED? I sure never do. Most times when I see a lac, I cringe, knowing that it's going to eat up a nice chunk of time and trying to figure out when I can drop everything to take care of it can sometimes be a challenge during the busy parts of the day/night.

 

[Old_Mil]

I got told that a couple time when I was a MS4 in doing my home ED rotation. At the time I was proud of the comment. It hit me a couple years later, when I was supervising an MS4 taking a looong time to sew a lac, I said gently "it doesn't have to be a plastics job", that perhaps it really wasn't a compliment I was getting. Oh well.

You'll find that the emphasis on speed and throughput in an emergency department (and, by correlation the willingness to rush through stuff in not necessarily the most thorough of fashions) depends to what role RVUs pay in an ED doctor's paycheck.

When you're paid for piecework, speed is of the essence even if patient care averages a B+ instead of an A.

 

[GeneralVeers]

You'll find that the emphasis on speed and throughput in an emergency department (and, by correlation the willingness to rush through stuff in not necessarily the most thorough of fashions) depends to what role RVUs pay in an ED doctor's paycheck.

When you're paid for piecework, speed is of the essence even if patient care averages a B+ instead of an A.

Piecework and efficiency will become even more important as Medicare/Medicaid reimbursement gets slashed or doesn't keep up with inflation. Salary is not the answer either, as I know a number of docs who already do the minimum. Putting them on salary would make them slower and even more annoying to work with.

 

[tkim]

You'll find that the emphasis on speed and throughput in an emergency department (and, by correlation the willingness to rush through stuff in not necessarily the most thorough of fashions) depends to what role RVUs pay in an ED doctor's paycheck.

When you're paid for piecework, speed is of the essence even if patient care averages a B+ instead of an A.

Uh, thanks.