For those who suture

[GetMeOuttaThisMess]

Just curious to see if any forego simple interrupted sutures for my all time favorite, the running horizontal mattress? I haven't had to suture in over a decade but some online videos which shall remain nameless (uh, pimples, etc.) show inversion of skin edges on closure whereas I NEVER had a wound, including facial, return for dehiscence. Scarring from later visits for other issues always looked great. In the ED time was money and I will forever be thankful to my director for clueing me in that it was standard of care with Plastics at UTSW. Did I mention that it's a heck of a lot faster also! Loved these closures for parking lot license plate bites.

[BruceBanner]

I usually default to simples but after some tough skin tension wounds I think I may start using the horizon mattress again. I never thought of running it.

[ohiovolffemtp]

I sew a lot.  According to the CO's, I have a good reputation for my work at 2 state prisons (or they're BS'ing the inmates).  I mostly use simple interrupted, because many of the lacs are very jagged and stellate.  For long straight lacs that aren't too gaping, I tend to use running locked.

[EMEDPA]

I like em. here is a short video on the technique:

[sk732]

I use mattresses more often than not...I'll do the running horizontals when dealing with cutters, as you can get parallel incisions done at the simultaneously and save time...and oddly enough, they're usually not too worried about scarring (though it tends to be minimized this way).  I use alot of vertical mattresses as well, on knees, elbows or parts of the back.  I've always found that the eversion of the skin keeps the scarring down and they generally heal well.  Other thing with horizontal mattresses - half the knots to cut and take out.

 

SK

[EMEDPA]

cutters get staples. end of story.

[ventana]

first thougth

 

We suture FAR to much - glue, steri's and even just a big old piece of cloth adhesive tape left in place for a week - gives a FAR better cosmetic outcome then suturing.....

 

Having said that

 

I would usually use simple interrupted for traumtic lesions - they are just messy.... and simple interrupted, sometimes with a horizontal or vertical mattress thrown in works.... (yup have done both in the past)

 

then my favorite for very clean lac's or areas that are surgical incisions - running horizontal subq with a prolene or ethilon - with a simple and knot at each end - TINY needle - into the skin at the incision and back out - across to other side and repeat - remove in 7-10 days by clipping on end - pulling lightly while clipping the other end and the whole thing comes out - tincture and steri's applied and a GREAT cosmetic outcome!! this is sort of it - I started and end differently.... Have also used absorbable but still removed them

 

So conclusion

simple interrupted for most trauma - but can use mattress sutures for high tension, or cosmetic places

 

Then the sub q for clean surgical like lower tension areas

 

and always think about non-suture closure first.....

 

 

Head Lacs - ALWAYS get staples in the hair - DON'T put sutures in - they STINK to get out!! don't torture the folks taking them out

Agree cutters get staples - and I ask them if they want to be numbed up or not - many times they say no.....

[Guest JMPA]

running subq suture is fast and provides the best cosmetic outcome

[sk732]

I will usually numb up everyone, as most, with few exceptions appreciate it (even guys with tattoos like me).  Cutters still get sewn by me, unless they only went superficial and then they get glue and tape...even though many have been touched by the baseball bat of God while eating Cocoa Puffs, I still treat them like people  Agreed, we don't use near enough glue...if they could come up with a better dispensing device than currently used, I'd be a lot happier (the previous Dermabond tube was much better and economical than the current POS pen).  I do often use dissolving sutures for things like the head or if the person doesn't have someone to take them out readily.  My main SP is an ex-plastic surgeon and I almost never see him use a running subcut suture in the ER - just well placed suures, tied just so and as tiny as allowable, with a bit of undermining if needed to drop some tension off.  I'm starting to steer towards more steri-striping as well for certain wounds...still not fully sold on high tension avulsions yet, but working on it.

 

I actually had someone ask me not to freeze them - the sutures were right by the eye, so I made them pinky swear that if they flinched and I sewed their eyebrow to their cornea that they wouldn't sue me...

 

SK

[d2305]

I've sutured lacs from head to toe literally. 6-0 nylon works well for the face.

[CAAdmission]

 For long straight lacs that aren't too gaping, I tend to use running locked.

 

These are good for bloody scalps, but they put a ton of pressure on wound edges where you want some capillary blood flow.

[BruceBanner]

cutters get staples. end of story.

 

I remember in school I was sewing up a cutter in the ER. The attending said, and I quote "I don give a f*ck how you close it. I don't care if you use duct tape. If she doesn't care about her life get her out of my ER."

[Wellness]

I remember in school I was sewing up a cutter in the ER. The attending said, and I quote "I don give a f*ck how you close it. I don't care if you use duct tape. If she doesn't care about her life get her out of my ER."

 

I hope you retorted with a more compassionate POV. 

[sk732]

Just tossed in a couple of 6-0 gut whip stiches into a lac on a sublingual vein that was gushing...that was an adventure, trying to get buddy to keep his tongue still.  To quote Action Figure Therapy - "Problem solved...problem staying solved".

 

SK