Material
Sterile on the instrument table:
- 1 blade handle with blade no. 15.
- Needle holder.
- 2 pairs of tweezers (1 surgical, 1 anatomical).
- 1 pair of surgical scissors.
- 1 pair of bent dissecting scissors.
- 2 mosquito forceps.
- 1 Kocher forceps.
- 2 retractors.
- Sterile gauze pads 10 × 10 cm.
- 1 fenestrated drape.
- Suture thread.
- A 10-ml syringe with injection needle for wound irrigation.
- A 2- or 5-ml syringe with fine needle for infiltration.
Unsterile, within reach:
- Disinfectants.
- Local anaesthetic.
- Irrigation solution.
- Bandaging material.
- Bandage scissors.
Procedure
- Ask the patient about allergies to iodine and/or local anaesthetic.
- Tell the patient what you are about to do.
- Ask the patient to lie down.
- Adjust the lighting.
- Clean the area around the wound with soap and water and shave away any hair, if necessary.
- Disinfect the edges of the wound and surrounding area (povidone-iodine).
- Put on sterile gloves.
- Cover the wound with a sterile fenestrated drape.
- Infiltrate the wound area with local anaesthetic, which is standing ready and sterile by the instruments. Alternatively, administer guided anaesthesia using the Oberst method for a wounded finger or toe.
- Check whether the anaesthesia has taken effect and rinse the wound with NaCl 0.9%, which is standing ready and sterile by the instruments.
- Inspect the wound bed and remove any foreign bodies with tweezers.
- Excise non-viable tissue and irregular wound margins. For facial wounds, excise very conservatively; excision of wound margins is usually unnecessary in this highly vascularised area.
- Staunch the flow of blood by temporarily clamping blood vessels. Bleeding usually stops after a few minutes. Blood vessels may have already coagulated. If insufficient haemostasis is achieved through coagulation, tie off or stitch around the vessel with reabsorbable suture (if tying off the vessel is not possible due to the short length of the vessel, a suture is placed at the site of the bleeding vessel).
- To tie off a blood vessel, clamp the bleeding vessel with mosquito forceps [Figure 14], then place a loose suture under the forceps to surround the vessel and tie by hand.
Figure 14
- To stitch around a blood vessel, take an atraumatic rounded needle with reabsorbable suture and suture around the bleeding vessel and into the adjacent tissue, then pull the suture tight and tie a knot in the thread making use of the needle holder to do so [Figure 15].
Figure 15
- Close the wound, unless there is reason to leave it open (see “Theoretical Background”). At least cover the wound with a wet bandage.
- Apply a wound covering bandage (see “Set-up and Equipment”) and a pressure bandage if necessary, and make a sling if the wound involves the upper extremities.
- Provide adequate tetanus prophylaxis (see “Theoretical Background”).
- Discuss with the patient any complications that may occur, when a wound check-up is needed, and guidelines for rest/activity of the treated body part.