PR-Luka

Cleanser
• Normal saline
In most instances, simply washing the open wound with saline under pressure
removes most of the surface bacteria
• Non ionic surfactant
The nonionic surfactant Pluronic polyol F-68 has been shown to be effective
as a wound cleansing agent without demonstrably impairing resistance to
infection or wound healing
• Hydrogen peroxide
The foaming action of hydrogen peroxide is frequently used to remove
particulate debris and recently clotted blood from wounds. A dilute solution
of hydrogen peroxide is very useful for removing dried blood and debris from
around wound edges. Undiluted hydrogen peroxide should probably not be
used directly in a wound due to risk of cytotoxicity

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc
Graw Hill. 2008. 465-87
 Cleanser
• Ionic soap and detergent
Ionic soaps and detergents (e.g., pHisoHex) should not be used for wound
cleansing, because they are extremely irritating to tissues and increase the
potential for infection if used directly on the wound. They may be used for
cleansing of intact skin surrounding the wound, although they have not been
shown to be superior to ordinary soap or other agents for this purpose. After
application, they should be removed by thorough rinsing with water
• Skin disinfectan and atimicrobial
The use of 1% povidone-iodine to irrigate wounds is widely debated.
Concentrated iodine is cytotoxic, but evidence is mixed regarding the use of
the dilute solution for wound care. There is probably no significant advantage
or disadvantage to dilute povidone-iodine solution compared to normal
saline. Irrigation of wounds with antibiotic solutions has been associated with
a slightly decreased rate of wound infection but at a much greater cost

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc
Graw Hill. 2008. 465-87
 Suture selection
Absorbable
Absorbable sutures are biodegraded and lose their tensile strength in 2-6
weeks.
• Gut Sutures
Sutures derived from sheep submucosa or beef serosa are digested by
proteolytic enzymes in the wound. They are more rapidly degraded in the
presence of infection. The knot-holding ability of plain gut is rather
inconsistent; chromic gut seems to be better in this regard
Ex:
1. Plain gut—Plain gut incites an intense inflammatory reaction in the
wound and loses its tensile strength within 2 weeks
2. Chromic gut—Treatment of gut with chromium salts decreases its tissue
reactivity and prolongs its survival to about double that of plain gut. In
some studies, however, it has been shown to potentiate infection more
than the plain gut

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc
Graw Hill. 2008. 465-87
 Suture selection (absorbable)
Synthetic Sutures
• Polyglycolic acid (Dexon), polyglactin (Vicryl), and polydioxanone (PDS)
produce minimal tissue reaction in the wound and are most commonly
used for dermal and subcutaneous closures and vascular ligation.
• Degradation—Polyglycolic acid and polyglactin are degraded by hydrolysis
and lose 50% of their tensile strength in 14-20 days and about 90% by the
fourth week (comparable to chromic catgut). Polydioxanone, a third-
generation synthetic absorbable suture, loses 50% of its tensile strength in
5 weeks and 90% at 2 months
• Tying qualities—Although similar to silk in their handling characteristics,
polyglycolic acid and polyglactin sutures do not hold knots quite as well.
Polydioxanone looks, feels, and handles like monofilament nylon or
polypropylene
• Use in acute wounds—Absorbable synthetic sutures are probably superior
to gut sutures in acute wounds because of their low tissue reactivity and
resistance to degradation in the presence of infection. The monofilament
characteristics of polydioxanone make it almost the ideal synthetic
absorbable suture

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc
Graw Hill. 2008. 465-87
 Suture selection
Non Absorbable
• Silk
Silk sutures represent the most common type of
natural fiber suture. Silk gradually loses its tensile
strength and is classified as a slowly absorbable
suture material. The tissue reactivity of silk is the
greatest of all nonabsorbable sutures, and its use in
acute wounds has generally been abandoned

Stone CK. Emergency Medicine: Current Diagnosis

and Treatment 6th Ed. Mc Graw Hill. 2008. 465-87
• Syntethic suture
1. Dacron—Dacron is a polyester that elicits less tissue reaction than silk. Because
of its high friction coefficient, it is as difficult to handle as a suture. The friction
injury imposed on the tissues by Dacron can be overcome by coating it with
Teflon
2. Nylon—Nylon causes less tissue reactivity than Dacron, and its use in
contaminated wounds results in lower wound infection rates. Monofilament
nylon sutures lose approximately 20% of their tensile strength within a year after
placement in a wound. The monofilament form of nylon is quite stiff and does
not hold knots well. Multifilament nylon sutures completely lose their tensile
strength in the wound after 6 months, but they are easier to tie than
monofilament sutures
3. Polypropylene and polyester—Polypropylene and polyester materials cause the
least reactivity of all suture materials. They maintain their tensile strength
indefinitely and are the suture material of choice for closure of contaminated
wounds. These materials are used most commonly for fascia and skin closure.
They are also advantageous in the repair of vascular, nerve, and tendon injuries.
Because of their softer consistency, these materials generally hold knots better
than does nylon

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc Graw Hill.
2008. 465-87.
Longmore M, Wilkinson IB, Baldwin A, Wallin E. Oxford Handbook of Clinical Medicine 9th
ed. New York: Oxford University Press.. 2014. 573.
 Time to remove

Wyatt JP, Illingworth RN, Robertson CE, Clancy MJ, Munro PT. Oxford Handbook of
Accident and Emergency Medicine. New York. Oxford University Press. 2005. 393.
Tendon repair
 Muscle repair
Muscle and fat do not hold sutures well, and closure is performed primarily to
obliterate dead space. Dead space results from traumatic tissue loss, debridement, or
gaping of subcutaneous layers. Suturing of dead space invariably produces additional
tissue trauma and necrosis and is contraindicated in the closure of contaminated
wounds. When such suturing is performed, it should be accomplished with the fewest
possible loosely placed sutures. Chromic gut or one of the synthetic absorbable
sutures should be used for this purpose.

Stone CK. Emergency Medicine: Current Diagnosis and Treatment 6th Ed. Mc Graw Hill.
2008. 465-87.