Best book for suturing?

[socrates89]

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Lets say a patient comes to you with a deep laceration on the palm involving laceration of underlying muscles, do you stitch the muscles or only close the skin with subq's/ interrupted stitches? Is there any book that tells you how to deal with such trauma cases and how to manage such cases?

When would you do subQ's vs. deep mattress? scenarios like that. I want to learn the proper management plans for the various types of lacerations? I'm not sure if that comes under plastics and I should look under plastics, but I didn't find any book under Gen surg that taught suturing techniques, types of stitches and where and when each is specifically applied

 

[Dr.LeoSpaceman]

Try Tools of the Trade and Rules of the Road. It's older and out of print, but your hospital library may have it. It has a lot of great info about "basics" that I think some of us are afraid to ask about.

 

[sleeping]

http://www.amazon.com/Surgical-Sutu...qid=1373524100&sr=1-1-spell&keywords=suturibg

 

[socrates89]

http://www.amazon.com/Surgical-Sutu...qid=1373524100&sr=1-1-spell&keywords=suturibg

This is the exact book I was referring to earlier, its not very informative, very brief simply tells the types of stitches, not really when to use which one.

 

[Pir8DeacDoc]

Where are you in your education? Some of what it seems you want are things you learn in residency. What to use where comes from practice and experience.

 

[socrates89]

where are you in your education? Some of what it seems you want are things you learn in residency. What to use where comes from practice and experience.

ms-4, I understand much of what I want to learn is through experience, but i thought some of this could be learned from books. I don't mean to jump the gun here in terms of experience but I wouldn't mind being strong in this part of surgery before residency actually starts

 

[kaleerkalut]

Where are you in your education? Some of what it seems you want are things you learn in residency. What to use where comes from practice and experience.

True, but I've seen attendings (including my own during my MS3 rotations) ask med students "so what would you like to use on this wound/laceration/etc" and then when you make a choice "explain why". I think this attending is unique, but it is not unheard of.

 

[Pir8DeacDoc]

True, but I've seen attendings (including my own during my MS3 rotations) ask med students "so what would you like to use on this wound/laceration/etc" and then when you make a choice "explain why". I think this attending is unique, but it is not unheard of.

I wasn't implying you shouldn't understand this in a basic way. But specifics, which it seems OP is seeking, are generally from experience. But you should know which sutures are absorbable, which are synthetic, which are braided, and roughly how long skin sutures will last and when/if they should be removed. Glad you guys are interested in learning this!

 

[Kahreek]

i think doing a suture list and some google research would be the best, to find different suture scenarios. Because most surgical textbooks describe suture type within a set procedure. And another thing some choices are not really a consensus among surgical community.
For instance in a deep palmar laceration i would primarly be concerned about cut tendons, and then tendon stiching technique would be necessary.

 

[kaleerkalut]

I wasn't implying you shouldn't understand this in a basic way. But specifics, which it seems OP is seeking, are generally from experience. But you should know which sutures are absorbable, which are synthetic, which are braided, and roughly how long skin sutures will last and when/if they should be removed. Glad you guys are interested in learning this!

Thanks. Yes, but what is a good resource to learn the things you've listed in your post?

 

[Pir8DeacDoc]

Thanks. Yes, but what is a good resource to learn the things you've listed in your post?

There are practical guides put out by the suture industry that can be helpful. We had a terrific lecture from a plastic surgeon during our core surgery rotation in medical school. He brought a suture tree from his OR and reviewed each suture for the above things I mentioned. It doesn't stick the first time around but becomes pretty familiar over time.

You'll find that different types of surgeons close things differently to accomplish the same goal. Orthopods and Neurosurgeons live staples for skin. As an ENT I rarely use staples. This theme of subtle differences persists for deep closure as well. I use a lot of vicryl. Prs guys tend to use pds.

 

[skiz knot]

Lets say a patient comes to you with a deep laceration on the palm involving laceration of underlying muscles, do you stitch the muscles or only close the skin with subq's/ interrupted stitches?

You should probably consult a hand surgeon. If you have sustained a deep laceration to the palm that has involved the underlying muscles, you have likely violated vascular/nerve/tendinous structures along the way. You are probably not well trained to appropriately tackle this scenario as a general surgeon.

 

[SLUser11]

You should probably consult a hand surgeon. If you have sustained a deep laceration to the palm that has involved the underlying muscles, you have likely violated vascular/nerve/tendinous structures along the way. You are probably not well trained to appropriately tackle this scenario as a general surgeon.

When I was training, there were not too many things harder than getting a hand surgeon to come in for such a described scenario. Perhaps getting an ophthalmologist to come in was harder.

As a trauma resident, I would involve the orthopedic resident any time there was a tendon injury. At least that way it became their job to track down the hand surgeon.

I'm with you, though, in theory. Function is so important that you want an expert handling those situations. However, at 2am, it sounded a lot like when I'd call plastics: "Why don't you see what you can do/put it together the best you can, and I'll just fix it later if it needs it..."

 

[Pir8DeacDoc]

You should probably consult a hand surgeon. If you have sustained a deep laceration to the palm that has involved the underlying muscles, you have likely violated vascular/nerve/tendinous structures along the way. You are probably not well trained to appropriately tackle this scenario as a general surgeon.

Agree with you but I think they were just using a scenario to make their question more clear.

 

[Oryza]

ethicon wound closure manual and tintinalli em chapters on wound management are helpful to me

 

[alamo4]

http://surgery.uthscsa.edu/pediatric/training/woundclosuremanual.pdf

It's pretty good.

ethicon wound closure manual and tintinalli em chapters on wound management are helpful to me