30 September, 2014
Today was a day full of suture and staple removals.
I saw an adolescent girl who sustained a laceration to her leg after standing on a glass table. The laceration was jagged, but the ER did a fantastic job of approximating the edges and putting nice tight sutures.
I have a few tricks for a successful suture removal.
One is to hold the knot with the forceps. This way, you never make the mistake of cutting the knot. Second is to wiggle the suture a bit to pull it away from the skin, pulling the knot to one side. When cutting the suture, I try to cut at the opposite side of the knot and then pull from the knot end. This way, you are not pulling exposed suture through the tissue, lessening the chances of introduction of bacteria.
Staple removals are far easier, but today a provider experienced a problem. Staple removals involve using a tool that gets underneath the staple and bends then ends upward. For some reason, removing the last staple, the staple bent the opposite way. Even simple procedures can go wrong. We attempted to cut the staple and remove the two sides, but were unable to find a cutter strong enough. The provider was finally able to remove the staple by using the staple remover repeatedly until it would bend correctly and could be wiggled free.
The most difficult suture and staple removals are in the very young population who are very squirmy. It is important to hold them still, especially if the sutures are on the face. I suggest wrapping them in a blanket and having two assistants holding the patient.
I can’t wait to be able to place sutures some day! We had a practice lab for suturing, but I need a lot more practice! I have a rotation in the urgent care coming up, so hopefully I’ll get the chance to try.