Wound suturing - troubleshooting

[boanssi]

Hello!

I've started suturing and I've come across some difficult steps along the way:

- I'm finding the injection of local anaesthetic (é.g. lidocaine) troublesome because I feel like I have to exert too much force on the plunger for the anaesthetic to come out and, even so, very little quantities actually enter the skin.

Thank you

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[Winged Scapula]

Hello!

I've started suturing and I've come across some difficult steps along the way:

- I'm finding the injection of local anaesthetic (é.g. lidocaine) troublesome because I feel like I have to exert too much force on the plunger for the anaesthetic to come out and, even so, very little quantities actually enter the skin.

Thank you

Think back to your physics studies and the laws regarding pressure. then look at the diameter of the needle and syringe you're using and see if you can figure it out.

 

[TMP-SMX]

A 30 gauge is fine for injecting lido with a 3cc or 5cc syringe. Make sure the needle isn't clogged (can sometimes crystallize if left for long periods of time). Inject bevel up at a 45 degree angle. Before putting pressure on the plunger go into the subcutis and inject as you withdraw (creates a channel for fluid to enter). This is especially important for injecting keloids with Kenalog since there is thick scar preventing infiltration of the area. For these types of things you need to use a much larger gauge (25 etc.). If you are injecting into abnormal skin (scar or etc) inject outside of that area and you can infiltrate spreading it dermally to the next area you are going to inject.

 

[Winged Scapula]

My staff is always trying to give me a 50 cc syringe and a 25 gauge needle. My ripped biceps must confuse them

 

[dr zaius]

18 gauge for local or bust.

Dudes love it for vasectomies.

 

[rigid]

thread titled wound suturing troubleshooting... problem actually involves injecting local anaesthetic...

 

[ThoracicGuy]

18 gauge for local or bust.

Dudes love it for vasectomies.

 

[Winged Scapula]

thread titled wound suturing troubleshooting... problem actually involves injecting local anaesthetic...

OP posts thread asking for advice.Doesnt come back to say thanks or participate in discussion.

 

[boanssi]

A 30 gauge is fine for injecting lido with a 3cc or 5cc syringe. Make sure the needle isn't clogged (can sometimes crystallize if left for long periods of time). Inject bevel up at a 45 degree angle. Before putting pressure on the plunger go into the subcutis and inject as you withdraw (creates a channel for fluid to enter). This is especially important for injecting keloids with Kenalog since there is thick scar preventing infiltration of the area. For these types of things you need to use a much larger gauge (25 etc.). If you are injecting into abnormal skin (scar or etc) inject outside of that area and you can infiltrate spreading it dermally to the next area you are going to inject.

Thank you for providing a clear and thorough answer to my question.

OP posts thread asking for advice.Doesnt come back to say thanks or participate in discussion.

Well...maybe that's because only one person in this thread actually cared enough to give a thorough and polite answer to the question, while of rest of you used your precious time to send me a nice little "f*** you" post. Thank you so very much.


(...)Anyway...to those of you who actually care about this topic, here's another question: where can I find a guide to the various suture materials and their correct applications?

 

[Winged Scapula]

Thank you for providing a clear and thorough answer to my question.



Well...maybe that's because only one person in this thread actually cared enough to give a thorough and polite answer to the question, while of rest of you used your precious time to send me a nice little "f*** you" post. Thank you so very much.


(...)Anyway...to those of you who actually care about this topic, here's another question: where can I find a guide to the various suture materials and their correct applications?

Ok...

so telling you to think about it is a "F U?"

I'll bet you're a lot of fun on rounds when your attending asks you to look something up or figure it out rather than just giving you the answer.

I'm not sure how to respond to that because that certainly was not our intention nor do I see anywhere where anyone was being rude to you.

 

[da8s0859q]

Well...maybe that's because only one person in this thread actually cared enough to give a thorough and polite answer to the question, while of rest of you used your precious time to send me a nice little "f*** you" post. Thank you so very much.


(...)Anyway...to those of you who actually care about this topic, here's another question: where can I find a guide to the various suture materials and their correct applications?

Sorry, I know we all owe you our time and advice and everything, but how much searching have you done to attempt to answer your own question?

 

[TMP-SMX]

Thank you for providing a clear and thorough answer to my question.



Well...maybe that's because only one person in this thread actually cared enough to give a thorough and polite answer to the question, while of rest of you used your precious time to send me a nice little "f*** you" post. Thank you so very much.


(...)Anyway...to those of you who actually care about this topic, here's another question: where can I find a guide to the various suture materials and their correct applications?

No problem, but it's best not to poke the bear. If the question was answered everyone else was using humor.

There's tons of literature on suture types, benefits, drawbacks etc. Here's a good diagram for you. No suture is perfect. You are often trading one thing for another. On the face I like prolene (polypropylene) for the epidermal stitch. It's also good on the scalp because it's blue and stands out against dark hair (nylon is black). Monocryl (poliglecaprone 25) slides very well whereas vicryl (polyglactin 910) does not since it is braided. I don't use a lot of silk or catgut since they are very reactive. 3-0 on trunk and sometimes scalp. 4-0 on extremities/parts of neck. 5-0 or 6-0 on face. In terms of needle size the smaller the number the larger the needle (PS-2 is a big needle compared to P3).

 

[armybound]

There's no hard and fast rule about which sutures to use when, though there are some guidelines which would likely be field-specific. I know all of my staff will perform the same procedure with different suture and different techniques with equivalent results, and they're all confident that their way is the only right way to do it.

When I'm choosing suture I think of whether I want permanent or absorbable, how long I want the suture to stay around if it is absorbable, whether I want braided or monofilament, and how large or fine I want the suture to be. Then you choose your suturing technique based on what the goal of your suture is, e.g. strength vs cosmesis.

 

[Buzz Me]

If I were still a mod I would have moved this thread over to the Clinical Rotations forum - this concerns a medical student issue, not a surgical residency issue.

And I would tone down that indignant attitude if I were you. I'm hoping you're just that angry and outraged because it's an anonymous online forum...and that you're not like that on your actual rotations.