Utilizing Different

Laceration Closure
Techniques in
Emergency
Medicine

Amaryllis (Amy) Dunklee

Independent Study Mentorship
Spring 2019
Source: Creative
Commons Mrs. Click
 DISCLAIMER:
Some of the information within this presentation

came from outside sources and will be cited at the

end.

pa
ge
2
Contoso
Pharmaceuticals
This Photo by Unknown Author is licensed This Photo by Unknown Author
under CC BY-NC is licensed under CC BY-NC
Mentor: Dr. Wayne Rutledge, MD
• Mentor’s Place of Business:
UTMB Victory Lakes Emergency
Department
• Mentor’s Profession: Emergency Medicine
Physician
• Mentor’s Education:
• Undergrad: University of South Florida
• Medical School: Ross University
• Residency: UTMB,
• Specialization in internal medicine.

UTMB Health Locations: pa

ge
League City Campus. League
City.

UTMB Health Brand

Contoso3
Management Team. UTMB Pharmaceuticals
Health Logo: Full-Color Logo.
Project Topic
• My project topic is geared toward the many
laceration closure techniques Emergency Medicine
Physicians utilize.
• Last year, my product consisted of me performing
the interrupted suture technique on a pig’s foot. This
year will most likely be the same, however I will
attempt many other intricate sutures, such as the
vertical mattress suture.
• I chose to make my project about sutures because I
find them very interesting and the occur on a
regular basis in the ED.
pa
Source: Amy ge
4
Dunklee Contoso
Pharmaceuticals
 Independent Study Mentorship is a year long course study
in either Health Science or Multidisciplinary tracts
 Allows students to study a career area of interests
 Classwork involves designing projects and completing
assignments related to their mentorship.
 Students also observe their chosen profession a minimum of
3 hours per week.
 Students are also expected to perform all classwork at the
collegiate/ professional level.
Image Sources: Creative Commons

All About Independent Study

Mentorship Contoso
pag
e5

Pharmaceuticals
 Key Point #1: Introducing Lacerations
• Lacerations are defined as tears that occur
in tissue by a “shearing” or “crushing
force”.

• Blunt-trauma is usually the main result

for many lacerations.
• Most lacerations occur typically from any
sharp objects, (blade, knife, scissors), come
into contact with skin.
• Lacerations made by blunt force or trauma
are generally reffered to as “stellate”
lacerations. pa
ge
6
Source: Dr. Wayne Rutledge, Contoso
Pharmaceuticals
MD
 This Photo by

Key Point #2: Suture Techniques

Unknown Author is
licensed under CC
BY

• A suture is a medical application that holds tissue in order for the skin to
begin healing.
• There are many different sutures techniques that may be used in different
scenarios.
• “The Interrupted Suture” is one of the most applicable and widely used
suturing techniques. Each individual stitch are made at approximately 4-
6mm in length, and tied off from one another. It’s easy to remove and
common for emergency scenarios.
• “The Horizontal Mattress Suture” is a more complicated suture process.
This suture allows for ideal healing to occur between lacerated tissues. It’s an
effective suture for skin closure, but is more complicated and time pa
ge
consuming, and thus is not used as commonly for Emergency Practice. 7
 Simple Interrupted Suture VS Horizontal
Mattress Suture Pictures

Simple Interrupted Suture Horizontal Mattress Suture

Source: Incision.care.com Source: Incision.care.com pa
ge
8
Contoso
Pharmaceuticals
 Key Point #3: Different Forms of Suture Material
• The Purpose of utilizing certain materials The body may sometimes come as ribbed to
when suturing is to ensure that the ensure better grip when stitching a patient
wound will close correctly and not gain • Staples may be used on extremities that
any infection. may suffer under high tension, such as
• Absorbable sutures are used for the scalp.
placements where the sutures may need • The cost is generally greater for staples
to be buried deep within the skin, or used than traditional conventional sutures.
as an alternative in some cases. • The depth of any staple is judged by the
• Absorbable sutures are generally absorbed pressure exerted onto the skin.
completely in 70 days. • Staples should be inserted at 45 degrees
• The needles of sutures contain 3 different and 60-degree angles, to minimize trauma
parts. exerted onto tissue.
• The shank, body, and point.
• Contrary to the name, the body is the part
of the suture where the suture material is
attached to the needle. pa
ge
9
Contoso
Pharmaceuticals
This Photo by Unknown Author is licensed
under CC BY-SA
 Key Point #5: Laceration Follow-up and Aftercare
• After completing sutures or desired form of
treatment, the laceration or wound should be
covered with antibiotic ointment an dressing.
• At this point the Physician will clarify the
appropriate form of treatment, such as if he or
she should be referred to a specialist or follow
up with their PCP.
• They may reschedule an appointment to check
back in the ER to remove the sutures.
• The Physician will document in their note
what happened to the patient and specific
details such as the type of injury and the form pa
ge
of treatment chosen. Contoso 10
This Photo by Unknown Author is licensed under CC BY-SA Pharmaceuticals
Key Point #4: Treatment Changes Over Time
• Sutures and the way we address injuries have
changed tremendously over the last hundred years.
• Sutures have been around for thousands of years.
• The earliest recollection of suturing dates to 30,000
B.C. Humans in the Neolithic era utilized “Eyed
Needles” for surgery and tying wounds.
Galen of Pergamon, a Greek surgeon from 1600 B.C.,
records the use of silk or catgut (twisted intestines of
sheep/horses) as a good material for suturing
gladiators’’
• In 1876, Sir Joseph Lister, a British surgeon speaks
out about inspiring sterilizing medicine.
• Patient survival rates in hospitals grew
tremendously with the introduction of mass-
produced sterile sutures.
• “Mersutures” debut in the 1920’s. Mersutures are
eyeless needle sutures that already come with a
pre-attached strand, very similar to modern sutures
used today.
• In 1979, the addition of Vicryl allows the surgeons
knots to stay down, and allow for less trauma to
occur.
• In 1993, Monocryl sutures debuted and allowed for
the fascia within the skin to be pulled together
more compactly.
pa
ge
11
Source: Dr. Wayne Rutledge, MD,
Johnson & Johnson
 Research Slide
• The Military Medicine’s new device, “Derma Clip Skin
Closure Device”, is known as a “new, non-invasive, painless”
innovation that is helping revolutionize army medicine.
• The Derma Clip Device does not require the use of needles or
anesthesia.
• The device is mainly being used as applicable to emergency
medicine setting, and in any Battlefield setting.
• The source concluded that for sutures and staples, “there is
insufficient evidence to justify the use of staples over sutures”.

pag
e 12

Contoso
Pharmaceuticals
Source: Dr. Wayne Source: DermaClip
Rutledge, MD
Current Event Slide
• My project is focusing on the different laceration closure techniques seen
in Emergency Medicine.
• “TopClosure” is another innovation that shows significance at being
applicable in the US’s Emergency Department.
• It’s proven crucial in similar developing countries where costly materials
such as antibiotics, meshes, and skin grafts are rather limited.
• The device works by taking two clasps on
either side of incision/laceration, that are
then “adhered” to skin and tightened via
cable to seal said wound.
• It avoids the many disadvantages that
may come with traditional wound closure
such as suturing, which may place high
tension on skin. pa
ge
13
Source: TopClosure
Contoso
Pharmaceuticals
 Similar Products to Top Closure
Source: WebMD.com

• My project is focusing on lacerations, but burns are something

Emergency Medicine Physicians encounter.
• “BurnAid” is a company that creates products geared towards treating
burns. Many pad applications are incorporating the use of Lidocaine
along with the pain relieving gel.

• This “Disposable Surgery Skin Closure” device was recently passed by the
Chinese Food and Drug Administration. Online retails for $3.50 USD. Most
likely generic form of DermaClip.
• Consists of two adhesives on either side and can be adjusted. This device is
most likely intended for developing countries use, as it is effective device and
inexpensive. Source:
GlobalSources.com
• “Zip-Stitch” is another product with the same
“non-invasive” closure technique as top suture.
• Seen as an alternative to stitches due to the
pa
“at-home” ideal closure, and costing only $30.99 ge
on amazon. Contoso 14
Pharmaceuticals
Source: ZipStitch
Product Slide
•I will be highlighting my product, pigs foot laceration closure on this slide
with a video demonstration.

A video demonstration showing how to close a mattress suture

on a pig’s foot. I will be doing the demonstration.
1. Research different forms of laceration and study mattress
suture by February 28th.
2. Gain suture materials/pig’s feet needed to film video by March
16th.
3. Film Video of me performing mattress sutures on pigs foot by
April 6th.
pa
4. Edit Video and have completed before May 1st. ge
15
Contoso
Pharmaceuticals

Source: Creative Commons

 Product:
Video
Demonstration
Closure of
Simple
Laceration
Using
Horizontal
Mattress Suture
pa
ge
16
Contoso
Pharmaceuticals
In case suture video doesn’t work… Source: Amy Dunklee

Contoso
Pharmaceuticals

page 16
Artifacts!!! Source: Amy Dunklee
All of the following photos were taken with
patients verbal consent.

Contoso
Pharmaceuticals

page 18
 Contoso
Pharmaceuticals
Source: Amy Dunklee
All of the following photos were taken with page 19
patients verbal consent.
Source: Amy Dunklee Contoso
All of the following photos were taken with Pharmaceuticals
patients verbal consent.

page 20
 Conclusion
Slide
• Emergency Medicine really was an
amazing field to shadow. I thoroughly
enjoyed my experience. Seeing new
cases every day, and having a wide
variety of patients was one aspect I
really enjoyed about EM.
• I hope to gain more knowledge and
experience working with lacerations.
I want to learn more about
lacerations and hope to do well in my
HOSA COMPETITIONS! Source: Amy
Dunklee
pag
e 21

Contoso
Pharmaceuticals
 Thank you!

Thank you to my mentor, Dr. Rutledge for allowing to shadow

and learn from him! Thank you, graders/evaluators, Mrs.Alksne
and Mr. Mayberry, Thank you Mrs. Click for a being an amazing
teacher throughout ISM! Thanks Mom and Dad for being very
supportive!

pa
ge
22
Contoso
Pharmaceuticals

Source: Creative Commons

Works Cited/References
Huang, Ben. “Israeli Wound-Closure Technique Aims to Replace Surgical Suturing Worldwide | Health News.” NoCamels -

Israeli Innovation News, 4 Sept. 2018, nocamels.com/2018/09/israeli-wound-topclosure-surgery/.

Freed, Jeffrey S, and John Ko. “Innovative Advance in Non-Invasive Wound Closure: A New Paradigm.” OUP Academic,

Oxford University Press, 3 Apr. 2018, academic.oup.com/milmed/article/183/suppl_1/472/4960040. 20 Mar. 2019

Levine-October, Hallie. “Stitch in Time: 18 Fascinating Facts About the History of Sutures.” Content Lab - U.S., Johnson &

Johnson, 29 Oct. 2018, www.jnj.com/our-heritage/history-of-sutures-ethicon. 26 Mar. 2019.

Satteson, Ellen Stolle. “Materials for Wound Closure: Wound Healing and Closure, Suture Characteristics, Suture Materials.”

Materials for Wound Closure: Wound Healing and Closure, Suture Characteristics, Suture Materials, Medscape, 1 Feb.

2019, emedicine.medscape.com/article/1127693-overview. 26 Mar. 2019

pa
ge
23
Contoso
Pharmaceuticals
This Photo by Unknown Author is licensed under CC BY-SA-
NC