Preparing to Suture. 6 th Annual Pediatric Advanced Practice Conference Tuesday, February 9, :30 pm. Workshop B: Suturing for Beginners

Save this PDF as:
Size: px
Start display at page:

Download "Preparing to Suture. 6 th Annual Pediatric Advanced Practice Conference Tuesday, February 9, 2016 1:30 pm. Workshop B: Suturing for Beginners"

Transcription

1 Preparing to Suture Kristen Devick, MPAS, PA-C University of Colorado Department of Emergency Medicine NONE! Skin Anatomy Trott, 2012, p.11 Preparing to suture Initial evaluation Hemostasis Anesthesia Irrigation Wound exploration Closure of laceration History Mechanism of injury/other complaints Age of wound FB sensation? Allergies Tetanus status PMH Medications Page 1 of 10

2 As a general rule: Any injury <24 hours from time from injury, that can be converted with cleansing and débridement to a freshappearing, slightly bleeding, non-devitalized wound, with no visible contamination or debris after aggressive cleansing, irrigation, & débridement, can be considered for primary closure (Trott, 2012) Timing of Closure The chance of developing a wound infection increases each hour after the laceration occurred Trott, 2012 Physical Exam Location Size, shape, depth, contaminated/fb ROM (tendon injury or fx) Distal perfusion and sensation (Vascular and Nerve injury) Consent/Expectations Prior to anesthesia, informed consent of procedure (suture, staples, dermabond) Scar: all lacerations to skin will leave a scar. Benefit of closure is smaller scar. Possible infection Onset of Action Anesthetic Solutions Lidocaine 1 or 2% most commonly used Lidocaine with Epinephrine: Duration of action increased Vasoconstriction Myth vs Truth Epi contraindicated in areas with terminal circulation. Examples: fingers, nose, toes, ears. Trott, 2012, p.43 Page 2 of 10

3 Plane of Anesthesia for Local Skin Infiltration Digital Block Traditional Digital Block Vs Subcutaneous block Trott, 2012, p. 42 LET Lidocaine-Epinephrine-Tetracaine minute preparation Helpful in superficial laceration, abrasions, prior to cleaning, prior to local injection of anesthesia Summary of Wound Cleansing Agents Ready to Close? Wound should appear Visually clean & without contaminants Tissue pink & viable There is no active bleeding No FB Trott, 2012 Page 3 of 10

4 Suture Preparation NEJM video Questions? Resources Hollander J, Singer A. Emergency Wound Management. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma, OJ, Cline DM, editors. Tintinalli s Emergency Medicine. 6th ed. New York: McGraw-Hill; 2004; Trott, A. (2012). Wounds and Lacerations Emergency Care and Closure (fourth edition). Philadelphia, PA: Elsevier. Page 4 of 10

5 None! Principles and Techniques Kristen Devick, MPAS, PA-C Department of Emergency Medicine All lacerations will leave a scar. You can influence how good the outcome looks! Bite: amount of tissue taken when placing the suture needle into the skin The farther from the wound edge that the needle is introduced, the bigger the bite Throw: each suture knot consists of a series of throws. Square knot=2 throws, additional throws to secure the knot Percutaneous Closure (skin closure):sutures placed in skin with knot tied at surface Dermal Closure (deep closure): sutures placed in superficial (subcutaneous) facia & dermis with knot buried in the wound Usually absorbable sutures Page 5 of 10

6 Layer Matching: important to match each layer of a wound edge to its counterpart superficial fascia has to meet superficial fascia dermis to dermis Why? Proper wound healing & less scarring Needle driver Pickups (I prefer the toothed pickup) Scissors Non-Absorbable suture versus Absorbable Suture Needle size, curvature & cut. Most commonly used in the emergency setting. Enter and exit skin at 90 degrees. Evert edges Start by closing middle or most cosmetically sensitive Sutures should be placed just far enough from each other so that no gap appears between the wound edges. A. Suture needle is introduced at a 90-degree angle to the epidermis. B. The suture should be square. C. Incorrect technique and inversion, pitting As a general guideline, the distance between sutures is equal to the bite distance from the wound edge Page 6 of 10

7 RUNNING SUTURE INTERRUPTED SUTURES A Review of Several Techniques & Indication Sequence for tie of standard percutaneous closure Sequence for tie of standard percutaneous closure of deep & superficial closures Surgeons knot: two throws, then single throw. Usually 4-5 throws total. Similar to simple interrupted but no individual knots tied. Faster and efficient. Care must be taken with tying knot on opposite end Another useful method for wound edge eversion The horizontal mattress suture is often used in closing hand (palm & dorsum) lacerations The vertical mattress suture is helpful in areas of lax skin (e.g., elbow, dorsum of hand), where the wound edges tend to fall or fold into the wound. It can act as a deep & a superficial closure all in one suture. Page 7 of 10

8 Same start as simple interrupted A second bite is taken approximately 0.5 cm adjacent to the first exit & is brought back to the original starting edge, also 0.5 cm from the initial entry point. The knot is tied, leaving an everted edge. First take a large bite of tissue approximately 1 to 1.5 cm away from the wound edge & crossing through the tissue to an equal distance on the opposite side of the wound. Needle is then reversed & returned for a small bite (1 or 2 mm) at the epidermal/dermal edge to approximate closely the epidermal layer When wound edges are sutured together, inevitable tension & pressure is created in the tissue within the suture loop. It is important to minimize tension! Approximate don t strangulate. A. Drive the needle from deep in the wound to superficial. B. The needle is driven superficial to deep on the opposite side of the wound. C. The leading & trailing sutures come out on the same side of the cross suture. D. This same-side technique allows for the knot to be tied deep and away from the wound surface. E. If the same-side technique is not followed, the knot is forced to the wound surface by the cross suture and may protrude out of the wound. Trott, 2012 A. A few sutures, placed far apart & far from the wound edges, will increase wound tension. B. More sutures, placed closer together and closer to the wound edges, will reduce tension. Mastering this clinical skill Sutures can act as foreign bodies & can potentiate infection. Page 8 of 10

9 Best for lacerations with: low tension easy to approximate no oozing or bleeding clean & even edges that can be closed with no gaps Benefits: Less pain and time, slough off in 7-10 days, act as its own dressing, no antibiotic ointment needed p. 289 Linear lacerations of the scalp, trunk, & extremities. 1. Forceps are used to evert the wound edges before placement of each staple 2. Stapler is placed gently on the skin over the wound without indenting the skin 3. Trigger is squeezed gently & evenly to advance the staple into the tissue 4. When the staple is placed, a space should be visible between it & skin. A common mistake in placing staples is to apply excessive downward pressure, causing the staples to seat deep in the wound. Staples are kept in place for the same length of time as are sutures in similar anatomic sites. Lip Lacerations: Vermillion boarder Lower Lip: avoid ectropion Lacrimal Duct/ Lid Margin: plastics or ophthalmologist Eyebrow 6 cm right upper arm laceration repair Anesthetized with 1% lido with epi, irrigated with 300 ml of NS, betadine prep and sterile drape. Explored: no vascular involvement, no apparent foreign body, no muscle or tendon involvement. Distal sensation intact. Closed with 4.0 monosoft interrupted sutures, 6 sutures. Good wound edge approximation. Topical antibiotics and dressing. Tolerated procedure well. Lacerationrepair.com Videos, photos, blog on laceration repair by EM physician Page 9 of 10

10 Trott, A. (2012). Wounds and Lacerations Emergency Care and Closure (fourth edition). Philadelphia, PA: Elsevier. Hollander J, Singer A. Emergency Wound Management. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma, OJ, Cline DM, editors. Tintinalli s Emergency Medicine. 6th ed. New York: McGraw-Hill; 2004; Page 10 of 10

Chapter 11. Everting skin edges

Chapter 11. Everting skin edges Chapter 11 PRIMARY WOUND CLOSURE KEY FIGURE: Everting skin edges In primary wound closure, the skin edges of the wound are sutured together to close the defect. Whenever possible and practical, primary

More information

TREATMENT 1. Control bleeding by applying pressure over wound with Gauze Pads (Surgical Supply-4). 2. Contact Surgeon for laceration repair options.

TREATMENT 1. Control bleeding by applying pressure over wound with Gauze Pads (Surgical Supply-4). 2. Contact Surgeon for laceration repair options. Page 1 of 8 pages NOTE Contact Surgeon before giving any medication marked with an asterisk. In an emergency or during Loss of Signal, begin appropriate treatment; then call Surgeon as soon as possible.

More information

The interrupted horizontal

The interrupted horizontal COVER ARTICLE OFFICE PROCEDURES The Mattress Sutures: Vertical, Horizontal, and Corner Stitch THOMAS J. ZUBER, M.D., Atlanta Medical Center, Atlanta, Georgia The interrupted vertical and horizontal mattress

More information

Suture Patterns. Objectives. Role of Suture Patterns. Inverting Suture Patterns. Appositional Suture Patterns

Suture Patterns. Objectives. Role of Suture Patterns. Inverting Suture Patterns. Appositional Suture Patterns Suture Patterns Objectives Introduction to Surgery Classify suture patterns based on their effect on tissue apposition Describe the steps involved in the accurate placement of basic suture patterns Discuss

More information

Wound Management and Basic Suturing Techniques. Disclosures

Wound Management and Basic Suturing Techniques. Disclosures Wound Management and Basic Suturing Techniques 10 July 2016 Douglas Winstanley, DO FAAD FACMS West Michigan Dermatology Grand Rapids MI Hugh Greenway s 33 nd Annual Cutaneous Anatomy and Surgery Course

More information

ADVANCED SUTURING WORKSHOP ANN BECKER, APRN-CNP; TONI PRATT-REID, APRN-CNP

ADVANCED SUTURING WORKSHOP ANN BECKER, APRN-CNP; TONI PRATT-REID, APRN-CNP ADVANCED SUTURING WORKSHOP ANN BECKER, APRN-CNP; TONI PRATT-REID, APRN-CNP SUTURING WORKSHOP! The technique of suturing, as a method for closing cutaneous wounds has been a part of medicine for hundreds

More information

Basic Wound Closure & Knot Tying. Joslyn Albright, MD General Surgery PGY-4 Research Resident

Basic Wound Closure & Knot Tying. Joslyn Albright, MD General Surgery PGY-4 Research Resident Basic Wound Closure & Knot Tying Joslyn Albright, MD General Surgery PGY-4 Research Resident Objectives Provide basic information on commonly used suture materials Review general principles of wound closure

More information

Integumentary System Individual Exercises

Integumentary System Individual Exercises Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this

More information

DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE

DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE 2012 LACERATION REPAIR REIMBURSEMENT GUIDE ETHICON, INC. IS PLEASED TO PROVIDE THIS LACERATION REPAIR REIMBURSEMENT GUIDE AS A RESOURCE FOR HEALTHCARE PROVIDERS. This guide is intended for informational

More information

Chapter 7. Expose the Injured Area

Chapter 7. Expose the Injured Area Chapter 7 GUNSHOT WOUNDS KEY FIGURES: Entrance/exit wounds This chapter describes how to treat the external, surface wounds caused by a bullet. The evaluation for underlying injury related to gunshot wounds

More information

Lacerations before Timing Animal Bites not Anesthesia

Lacerations before Timing Animal Bites not Anesthesia Lacerations A. History and initial evaluation Where and when the injury occurred Mechanism of injury Is there possibility of an underlying injury, retained FB, or bite? Size and location of the wound Sensory

More information

SUTURING. 1. Promote wound healing with least amount of scar and deformity. Adherence to these 2 principles will dictate how a wound is handled, the

SUTURING. 1. Promote wound healing with least amount of scar and deformity. Adherence to these 2 principles will dictate how a wound is handled, the SUTURIN Purpose A. Functional Close wound 2 Promote more rapid healing of wound Prevent Preserve infection function. Cosmetic 1. Promote wound healing with least amount of scar and deformity Adherence

More information

PHaSES: Practical Hands-on Surgical Education System

PHaSES: Practical Hands-on Surgical Education System U.S. Toll Free 866-GOLIMBS PHaSES Range PHaSES: Practical Hands-on Surgical Education System Limbs & Things is pleased to introduce the PHaSES Range. The range is based upon our well known basic & general

More information

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA Traumatic Primary Eyelid and Facial Laceration Repair Riva Lee Asbell Philadelphia, PA I INTRODUCTION I always have to work a little harder when coding for traumatic eyelid and facial repairs. There is

More information

Ankle Block. Indications The ankle block is suitable for the following: Orthopedic and podiatry surgical procedures of the distal foot.

Ankle Block. Indications The ankle block is suitable for the following: Orthopedic and podiatry surgical procedures of the distal foot. Ankle Block The ankle block is a common peripheral nerve block. It is useful for procedures of the foot and toes, as long as a tourniquet is not required above the ankle. It is a safe and effective technique.

More information

Plastic Surgery Jewish General Hospital / Montreal General Hospital

Plastic Surgery Jewish General Hospital / Montreal General Hospital Plastic Surgery Jewish General Hospital / Montreal General Hospital Structure of the Rotation Duration: Two weeks. Activities: Emergency Department consults Minor surgery Major surgery Plastics clinic

More information

Lesions, and Masses, and Tumors Oh My!!

Lesions, and Masses, and Tumors Oh My!! Lesions, and Masses, and Tumors Oh My!! Presented by: Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT DEFINITIONS OP REPORT CASES 2 Definitions Cyst - a closed sac having

More information

5 Upper eyelid blepharoplasty

5 Upper eyelid blepharoplasty 5 Upper eyelid blepharoplasty INSTRUMENTS Marking pen No. 15 scalpel blade Blade handle Castroviejo needle holder Castroviejo calipers 0.5 fixation forceps Westcott scissors 6-0 prolene suture Bovie cautery

More information

APPLICATION OF DRY DRESSING

APPLICATION OF DRY DRESSING G-100 APPLICATION OF DRY DRESSING PURPOSE To aid in the management of a wound with minimal drainage. To protect the wound from injury, prevent introduction of bacteria, reduce discomfort, and assist with

More information

Chapter 12. Anatomy of Skin. Epidermis. Dermis

Chapter 12. Anatomy of Skin. Epidermis. Dermis Chapter 12 SKIN GRAFTS KEY FIGURES: Skin anatomy with graft thickness Humby knife Using the dermatome Using the Humby knife Mesher Skin graft Tying the dressing in place Defatting the FTSG A skin graft

More information

Suturing Policy for Nurses in Emergency Departments

Suturing Policy for Nurses in Emergency Departments This is an official Northern Trust policy and should not be edited in any way Suturing Policy for Nurses in Emergency Departments Reference Number: NHSCT/12/545 Target audience: Registered Nurses Sources

More information

41 Assisting with Minor Surgery

41 Assisting with Minor Surgery Learning Outcomes 41.1 Define the medical assistant s role in minor surgical procedures. 41-2 CHAPTER 41 Assisting with Minor Surgery 41.2 Describe types of wounds and explain how they heal. 41.3 Describe

More information

3M Steri-Strip S Surgical Skin Closure. Commonly Asked Questions

3M Steri-Strip S Surgical Skin Closure. Commonly Asked Questions 3M Steri-Strip S Surgical Skin Closure Commonly Asked Questions What are the indications for use of 3M Steri-Strip S Surgical Skin Closure? Steri-Strip S Surgical Skin Closures are indicated as a primary

More information

Chapter 3. Ulnar nerve infiltration

Chapter 3. Ulnar nerve infiltration Chapter 3 LOCAL ANESTHESIA KEY FIGURES: Digital block/anatomy Sensation to hand Median nerve infiltration Ulnar nerve infiltration Facial block: skeleton Full surgical evaluation of a wound and suture

More information

Chapter 29. Initial Care

Chapter 29. Initial Care Chapter 29 FINGERTIP AND NAIL BED INJURIES KEY FIGURES: Digital tourniquet Bone rongeur Fingernail with hematoma Thenar flap Repair of nail bed Hand injuries are commonly encountered by health care providers

More information

Practical Plastic Surgery for Nonsurgeons

Practical Plastic Surgery for Nonsurgeons Practical Plastic Surgery for Nonsurgeons NADINE B. SEMER, MD Clinical Instructor Division of Plastic Surgery University of Southern California School of Medicine Los Angeles, California illustrations

More information

FUNCTIONS OF THE SKIN

FUNCTIONS OF THE SKIN FUNCTIONS OF THE SKIN Skin is the largest organ of the body. The average adult has 18 square feet of skin which account for 16% of the total body weight. Skin acts as a physical barrier for you to the

More information

Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S.

Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S. Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S. Global-HELP Publications Chapter Eight: TECHNICAL REQUIREMENTS FOR FORMATION OF A TUBED PEDICLE FLAP Creating a tube pedicle

More information

MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient

MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient C H A P T E R 4 5 MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient M. Jay Groves, IV, DPM Gastrosoleal equinus is a common deforming force on the foot and ankle.

More information

X-Plain Trigeminal Neuralgia Reference Summary

X-Plain Trigeminal Neuralgia Reference Summary X-Plain Trigeminal Neuralgia Reference Summary Introduction Trigeminal neuralgia is a condition that affects about 40,000 patients in the US every year. Its treatment mostly involves the usage of oral

More information

STANDARD OPERATING PROCEDURE #201 RODENT SURGERY

STANDARD OPERATING PROCEDURE #201 RODENT SURGERY STANDARD OPERATING PROCEDURE #201 RODENT SURGERY 1. PURPOSE The intent of this Standard Operating Procedure (SOP) is to describe procedures for survival rodent surgery. 2. RESPONSIBILITY Principal investigators

More information

JOB DESCRIPTION: SURGICAL TECHNOLOGIST

JOB DESCRIPTION: SURGICAL TECHNOLOGIST JOB DESCRIPTION: SURGICAL TECHNOLOGIST. The Standards and Guidelines for the Accreditation of Educational Programs in Surgical Technology have been approved by the Association of Surgical Technologists

More information

Endoscopic Plantar Fasciotomy

Endoscopic Plantar Fasciotomy Endoscopic Plantar Fasciotomy Introduction Plantar fasciitis is a common condition that causes pain centralized around the heel. It may be severe enough to affect regular activities. Health care providers

More information

Pressure Ulcers Assessing and Staging. Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010

Pressure Ulcers Assessing and Staging. Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010 Pressure Ulcers Assessing and Staging Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010 Never Events: Pressure Ulcers Pressure Ulcer Codes: MD documentation of pressure ulcers determines

More information

Chapter 33. Nerve Physiology

Chapter 33. Nerve Physiology Chapter 33 NERVE AND VASCULAR INJURIES OF THE HAND KEY FIGURES: Digital nerve location on finger Epineurial repair Nerves and blood vessels of the hand and fingers usually are quite delicate, and some

More information

7/11/2011. Pressure Ulcers. Moisture-NOT Pressure. Wounds NOT Caused by Pressure

7/11/2011. Pressure Ulcers. Moisture-NOT Pressure. Wounds NOT Caused by Pressure Assessment and Documentation of Pressure Ulcers Jeri Ann Lundgren, RN, BSN, PHN, CWS, CWCN Pathway Health Services July 19, 2011 Training Objectives Describe etiologies of pressure ulcers Discuss how to

More information

Chapter 34. Neglected hand Escharotomy

Chapter 34. Neglected hand Escharotomy Chapter 34 HAND BURNS KEY FIGURES: Neglected hand Escharotomy Severe hand burns are especially problematic injuries because of their propensity for causing long-term disability. Proper treatment of the

More information

WOUND MANAGEMENT PROTOCOLS WOUND CLEANSING: REMOVING WOUND DEBRIS FROM WOUND BASE

WOUND MANAGEMENT PROTOCOLS WOUND CLEANSING: REMOVING WOUND DEBRIS FROM WOUND BASE WOUND MANAGEMENT PROTOCOLS PURPOSE: Provide nursing personnel with simple guidance regarding appropriate dressing selection in the absence of wound specialist expertise Identify appropriate interventions

More information

Arizona State University Institutional Animal Care and Use Committee STANDARD INSTITUTIONAL GUIDELINE RODENT SURGERY

Arizona State University Institutional Animal Care and Use Committee STANDARD INSTITUTIONAL GUIDELINE RODENT SURGERY Arizona State University Institutional Animal Care and Use Committee STANDARD INSTITUTIONAL GUIDELINE RODENT SURGERY It is the policy of the IACUC that all survival surgeries involving rodents be conducted

More information

Joint Injections in Primary Care

Joint Injections in Primary Care Joint Injections in Primary Care MARC AIKEN MD Watauga Orthopaedics Objectives Understand when it is appropriate to inject /aspirate a joint Review common injection medications review pertinent anatomy

More information

Wound Care Management

Wound Care Management Rule Category: Billing ` Ref: No: 2012-BR-0007 Version Control: Version No. 3.0 Effective Date: 08 December 2012 Revision Date: August 2015 Wound Care Management Adjudication Rule Table of content Abstract

More information

Integra. Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE

Integra. Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE Integra Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE Table of contents Introduction Description... 2 Indications... 2 Contraindications... 2 Surgical Technique Step 1: Incision and Dissection...3

More information

Wound Classification Name That Wound Sheridan, WY June 8 th 2013

Wound Classification Name That Wound Sheridan, WY June 8 th 2013 Initial Wound Care Consult Sheridan, WY June 8 th, 2013 History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed

More information

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Wound and Skin Assessment Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Skin The largest Organ Weighs between 6 and 8 pounds Covers over 20 square feet Thickness

More information

Position Statement: Pressure Ulcer Staging

Position Statement: Pressure Ulcer Staging Position Statement: Pressure Ulcer Staging Statement of Position The Wound, Ostomy and Continence Nurses (WOCN) Society supports the use of the National Pressure Ulcer Advisory Panel Staging System (NPUAP).

More information

INTERNATIONAL MEDICAL COLLEGE

INTERNATIONAL MEDICAL COLLEGE INTERNATIONAL MEDICAL COLLEGE Joint Degree Master Program: Implantology and Dental Surgery (M.Sc.) Basic modules: List of individual modules Basic Module 1 Basic principles of general and dental medicine

More information

Interscalene Block. Nancy A. Brown, MD

Interscalene Block. Nancy A. Brown, MD Interscalene Block Nancy A. Brown, MD What is an Interscalene Block? An Interscalene block is a form of regional anesthesia used in conjunction with general anesthesia for surgeries of the shoulder and

More information

TENDON INJURIES OF THE HAND KEY FIGURES:

TENDON INJURIES OF THE HAND KEY FIGURES: Chapter 32 TENDON INJURIES OF THE HAND KEY FIGURES: Extensor surface of hand Mallet finger Mallet splints Injured finger in stack splint Repair of open mallet Most hand specialists believe that the earlier

More information

Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL)

Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL) Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL) Mark Glazebrook James Stone Masato Takao Stephane Guillo Introduction Ankle stabilization is required when a patient

More information

Chapter 30. Rotational deformity Buddy taping Reduction of metacarpal fracture

Chapter 30. Rotational deformity Buddy taping Reduction of metacarpal fracture Chapter 30 FINGER FRACTURES AND DISLOCATIONS KEY FIGURES: Rotational deformity Buddy taping Reduction of metacarpal fracture Because we use our hands for so many things, finger fractures and dislocations

More information

Dressing and bandage

Dressing and bandage Dressing and bandage Mihajlo Lojpur, M.D., Ph.D. INTRODUCTION The terms dressing and bandage are often used synonymously. In fact, the term dressing refers more correctly to the primary layer in contact

More information

Fingernail/Nailbed Wounds Animal Bites

Fingernail/Nailbed Wounds Animal Bites Fingernail/Nailbed Wounds Animal Bites Fingernail & Nailbed Injury Kent Benedict, MD, FACEP Clinical Associate Professor of Medicine Stanford University Crush Injury to Finger Crushed Finger X-Ray Anatomy

More information

Placement of Epidural Catheter for Pain Management Shane Bateman DVM, DVSc, DACVECC

Placement of Epidural Catheter for Pain Management Shane Bateman DVM, DVSc, DACVECC Placement of Epidural Catheter for Pain Management Shane Bateman DVM, DVSc, DACVECC Indications: Patients with severe abdominal or pelvic origin pain that is poorly responsive to other analgesic modalities.

More information

MOHS MICROGRAPHIC SURGERY

MOHS MICROGRAPHIC SURGERY MOHS MICROGRAPHIC SURGERY UMass Memorial Medical Center 55 Lake Avenue North Worcester, MA 01655 (508) 856-1666 Dr. Mary Maloney This booklet is intended to explain Mohs surgery to you. It is not, however,

More information

Injecting Inside the Mouth

Injecting Inside the Mouth Injecting Inside the Mouth 135 9 CHAPTER It is possible to treat a tooth without pain. You do this with an injection of local anesthetic. You must inject near the nerve, so to give good injections, you

More information

TAKING CARE OF WOUNDS KEY FIGURE:

TAKING CARE OF WOUNDS KEY FIGURE: Chapter 9 TAKING CARE OF WOUNDS KEY FIGURE: Gauze Wound care represents a major area of concern for the rural health provider. This chapter discusses the treatment of open wounds, with emphasis on dressing

More information

SHOULDER INSTABILITY. E. Edward Khalfayan, MD

SHOULDER INSTABILITY. E. Edward Khalfayan, MD SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are

More information

Femoral Nerve Block/3-in-1 Nerve Block

Femoral Nerve Block/3-in-1 Nerve Block Femoral Nerve Block/3-in-1 Nerve Block Femoral and/or 3-in-1 nerve blocks are used for surgical procedures on the front portion of the thigh down to the knee and postoperative analgesia. Both blocks are

More information

Eyelid Surgery - Lower

Eyelid Surgery - Lower Eyelid Surgery - Lower Are your eyes still one of the most striking features on your face? Do they convey your actual emotions and inner vitality, or do they make you appear fatigued, sad, or older than

More information

HCPCS AMERIGEL HYDROGEL DRESSINGS CODING GUIDANCE FOR:

HCPCS AMERIGEL HYDROGEL DRESSINGS CODING GUIDANCE FOR: HCPCS CODING GUIDANCE FOR: AMERIGEL HYDROGEL DRESSINGS FORM 1500 MUST HAVE THE FOLLOWING: APPROPRIATE HCPCS CODE APPROPRIATE A MODIFIER ACCURATE POS = 12 The Centers for Medicare and Medicaid Services

More information

Achilles Tendon Repair, Operative Technique

Achilles Tendon Repair, Operative Technique *smith&nephew ANKLE TECHNIQUE GUIDE Achilles Tendon Repair, Operative Technique Prepared in Consultation with: C. Niek van Dijk, MD, PhD KNEE HIP SHOULDER EXTREMITIES Achilles Tendon Repair, Operative

More information

Wound Management Wound Management in the Emergency Departme nt Hartmut Gross, M.D., FACEP

Wound Management Wound Management in the Emergency Departme nt Hartmut Gross, M.D., FACEP Wound Management in the Emergency Departme nt Hartmut Gross, M.D., FACEP Objectives After reading this chapter, the reader will be able to: 1. Understand the general process of wound healing. 2. Understand

More information

NIH Clinical Center Patient Education Materials Giving a subcutaneous injection

NIH Clinical Center Patient Education Materials Giving a subcutaneous injection NIH Clinical Center Patient Education Materials What is a subcutaenous injection? A subcutaneous injection is given in the fatty layer of tissue just under the skin. A subcutaneous injection into the fatty

More information

Dacryocystorhinostomy (DCR)

Dacryocystorhinostomy (DCR) Patient information Adnexal Dacryocystorhinostomy (DCR) Patient information about an operation to form a new tear drain between the eye and the nose when there has been a blockage What is dacryocystorhinostomy

More information

.org. Rotator Cuff Tears: Surgical Treatment Options. When Rotator Cuff Surgery is Recommended. Surgical Repair Options

.org. Rotator Cuff Tears: Surgical Treatment Options. When Rotator Cuff Surgery is Recommended. Surgical Repair Options Rotator Cuff Tears: Surgical Treatment Options Page ( 1 ) The following article provides in-depth information about surgical treatment for rotator cuff injuries, and is a continuation of the article Rotator

More information

Procedure -8. Intraosseous Infusion Adult and Pediatric EZIO. Page 1 of 7 APPROVED:

Procedure -8. Intraosseous Infusion Adult and Pediatric EZIO. Page 1 of 7 APPROVED: Page 1 of 7 Intraosseous Infusion Adult and Pediatric APPROVED: EMS Medical Director EMS Administrator 1. Goals/Introduction: 1.1 Intraosseous (IO) infusion provides an effective alternative means of providing

More information

PERCUTANEOUS PD CATHETER IMPLANTATION SYSTEM

PERCUTANEOUS PD CATHETER IMPLANTATION SYSTEM Place on Patient s Cranial Border of the Pubic Symphysis IMPLANTATION STENCIL Classic Exit Cuff Site PERCUTANEOUS PD CATHETER IMPLANTATION SYSTEM INSTRUCTIONS FOR USE VP 511 and VP-511M Implantation System

More information

Head and Neck Procedure Guide

Head and Neck Procedure Guide Head and Neck Procedure Guide Mr. Rodney Mountain MBChB FRCS (ORL)Ed Consultant Otolaryngologist Head and Neck Surgeon Department of Otolaryngology University of Dundee Scotland Mr. Peter Steele MBChB

More information

9.Pediatric Procedures

9.Pediatric Procedures 9.Pediatric Procedures A. Introduction 1. Pediatric blood collection may be by skin puncture or venipuncture. 2. Skill in pediatric phlebotomy is gained by knowledge of special collection equipment, observation

More information

Sutures and needles. Sutures

Sutures and needles. Sutures Sutures and needles Sutures A wide variety of material is available for suturing and ligating tissues. Sutures are selected for use according to the required function. For example, arteries are sutured

More information

Facial Sports Injuries

Facial Sports Injuries Facial Sports Injuries Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise

More information

KnifeLight. Carpal Tunnel Ligament Release. Operative Technique

KnifeLight. Carpal Tunnel Ligament Release. Operative Technique KnifeLight Carpal Tunnel Ligament Release Operative Technique Contents Page 1. Features & Benefits 3 Intended Use and Indications 3 Contraindications 3 Features & Benefits 3 2. Operative Technique 4 Antegrade

More information

Wound Care Charge Process

Wound Care Charge Process There are six components to the wound care charge process. 1. Visit evaluation and management levels 2. Nursing / Rehab Therapist procedures 3. Physician procedures 4. Diagnostic testing 5. Dermal tissue

More information

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Gallbladder removal is one of the most commonly performed surgical procedures. Gallbladder removal surgery is usually performed

More information

Taking Out a Tooth. Before You Begin: Ask Questions! CHAPTER11

Taking Out a Tooth. Before You Begin: Ask Questions! CHAPTER11 159 CHAPTER11 Taking Out a Tooth Not every painful tooth needs to come out. You must decide how serious the problem is, and then decide if you can treat and save the tooth. Some problems such as root canal

More information

High Pressure Water Jetting

High Pressure Water Jetting High Pressure Water Jetting Guidance Note 36 Jan 14 1 High Pressure Water Jetting Toolbox Talk. The term High Pressure Water Jetting covers all water jetting processes, including those using additives,

More information

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Patient Information Introduction This booklet is designed to give you information about having a Basal Cell Carcinoma near your eye and the

More information

A Patient s Guide to Guyon s Canal Syndrome

A Patient s Guide to Guyon s Canal Syndrome A Patient s Guide to DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or

More information

OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers

OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers Presented by: Rhonda Will, RN, BS, COS-C, HCS-D Assistant Director, OASIS Competency Institute 243 King Street, Suite 246 Northampton,

More information

EYE, EAR, NOSE, and THROAT INJURIES

EYE, EAR, NOSE, and THROAT INJURIES T6 EYE, EAR, NOSE, and THROAT INJURIES Management of injuries of the eyes, ears, nose, and throat focuses on airway management and initial stabilization of the injury. Bilateral comparisons can assist

More information

Arthroscopic shoulder stabilisation. Patient Information to be retained by patient

Arthroscopic shoulder stabilisation. Patient Information to be retained by patient PLEASE PRINT WHOLE FORM DOUBLE SIDED ON YELLOW PAPER Patient Information to be retained by patient affix patient label Shoulder instability The shoulder is the most common joint in the body to dislocate.

More information

Instructions for Use

Instructions for Use Pleural Effusion Shunt with External Pump Chamber Catalog No. 42-9005 Instructions for Use Denver Biomedical, Inc. Table of Contents Description 2 Indications 2 Contraindications 2 Warnings 4 Cautions

More information

Spinal Arthrodesis Group Exercises

Spinal Arthrodesis Group Exercises Spinal Arthrodesis Group Exercises 1. Two surgeons work together to perform an arthrodesis. Dr. Bonet, a general surgeon, makes the anterior incision to gain access to the spine for the arthrodesis procedure.

More information

Vascular Access. Chapter 3

Vascular Access. Chapter 3 Vascular Access Chapter 3 Vascular Access Introduction Obtaining vascular access in infants and children can be difficult even under optimal conditions. Attempting emergent access in a hypotensive, struggling

More information

Coding Dermatology Procedures. Presented by: Betty A Hovey Director, ICD-10 Development and Training AAPC

Coding Dermatology Procedures. Presented by: Betty A Hovey Director, ICD-10 Development and Training AAPC Coding Dermatology Procedures Presented by: Betty A Hovey Director, ICD-10 Development and Training AAPC 1 No part of this presentation may be reproduced or transmitted in any form or by any means (graphically,

More information

Lateral Ankle Instability Repair using TWINFIX Ti 3.5 mm Suture Anchors

Lateral Ankle Instability Repair using TWINFIX Ti 3.5 mm Suture Anchors *smith&nephew ANKLE TECHNIQUE GUIDE Lateral Ankle Instability Repair using TWINFIX Ti 3.5 mm Suture Anchors Prepared in Consultation with: James Calder, MD KNEE HIP SHOULDER EXTREMITIES Lateral Ankle Instability

More information

the revo / mini-revo shoulder fixation system s u r g i c a l t e c h n i q u e

the revo / mini-revo shoulder fixation system s u r g i c a l t e c h n i q u e the revo / mini-revo shoulder fixation system s u r g i c a l t e c h n i q u e REVO The following techniques are described by Stephen J. Snyder, M.D., Van Nuys, CA. Arthroscopic repair of the rotator

More information

COPYRIGHT ASPS. Breast Augmentation. The Symbol of Excellence in Plastic Surgery

COPYRIGHT ASPS. Breast Augmentation. The Symbol of Excellence in Plastic Surgery Breast Augmentation The Symbol of Excellence in Plastic Surgery A public education service of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. This brochure

More information

Adult Forearm Fractures

Adult Forearm Fractures Adult Forearm Fractures Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken. Fractures of the forearm can occur near the wrist at

More information

Bier Block (Intravenous Regional Anesthesia)

Bier Block (Intravenous Regional Anesthesia) Bier Block (Intravenous Regional Anesthesia) History August Bier introduced this block in 1908. Early methods included the use of two separate tourniquets and procaine was the local anesthetic of choice.

More information

Plantar Fascia Release

Plantar Fascia Release Plantar Fascia Release Introduction Plantar fasciitis is a common condition that causes pain around the heel. It may be severe enough to affect regular activities. If other treatments are unsuccessful,

More information

Chapter 35. Volar forearm fasciotomy incisions Hand/dorsal forearm fasciotomy incisions Finger fasciotomy incisions

Chapter 35. Volar forearm fasciotomy incisions Hand/dorsal forearm fasciotomy incisions Finger fasciotomy incisions Chapter 35 HAND CRUSH INJURY AND COMPARTMENT SYNDROME KEY FIGURES: Volar forearm fasciotomy incisions Hand/dorsal forearm fasciotomy incisions Finger fasciotomy incisions The previous chapters about the

More information

WOCN Society Position Statement: Pressure Ulcer Staging

WOCN Society Position Statement: Pressure Ulcer Staging WOCN Society Position Statement: Pressure Ulcer Staging Originated By: Wound Committee Date Completed: 1996 Reviewed/Revised: July 2006 Revised: August 2007 Reviewed/Revised: April 2011 Definition of Pressure

More information

Placement of an indwelling urinary catheter in female dogs

Placement of an indwelling urinary catheter in female dogs Female Dog Urinary Catheterization 1 of 6 Placement of an indwelling urinary catheter in female dogs Bernie Hansen DVM MS North Carolina State University College of Veterinary Medicine Materials Needed

More information

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary Introduction A Subclavian Inserted Central Catheter, or subclavian line, is a long thin hollow tube inserted in a vein under the

More information

Bard * PerFix * Plug. Technique Guide. A Modified Technique with the. Open Inguinal Hernia Repair

Bard * PerFix * Plug. Technique Guide. A Modified Technique with the. Open Inguinal Hernia Repair A Modified Technique with the Bard * PerFix * Plug A quick and simple preperitoneal underlay Modified Technique for the repair of groin hernias Technique Guide Open Inguinal Hernia Repair This technique,

More information

PRESSURE ULCER GUIDELINES FOR TOPICAL TREATMENT

PRESSURE ULCER GUIDELINES FOR TOPICAL TREATMENT PRESSURE ULCER GUIDELINES FOR TOPICAL TREATMENT The following are suggested guidelines for treatment of pressure ulcers using products from Swiss-American Products, Inc. and are intended to supplement

More information

Chapter 6. Hemorrhage Control UNDER FIRE KEEP YOUR HEAD DOWN

Chapter 6. Hemorrhage Control UNDER FIRE KEEP YOUR HEAD DOWN Hemorrhage Control Chapter 6 Hemorrhage Control The hemorrhage that take[s] place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him. Colonel

More information

Renal Vascular Access Having a Fistula For Haemodialysis

Renal Vascular Access Having a Fistula For Haemodialysis Renal Vascular Access Having a Fistula For Haemodialysis Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Plastic and Reconstructive Surgery

Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery General Description Office for Clinical Affairs (515) 271-1629 FAX (515) 271-1727 Elective Rotation This elective rotation in Plastic and Reconstructive Surgery (PRS)

More information