Wound becomes red, painful, with increasing pain, fever, drainage from wound. PLAN OF CARE: patient/family verbalized understanding of dx & POC, agreed with dx & POC did not agree with dx & POC - encouraged to seek second opinion. A health care team member must assess the wound to determine whether or not to remove the sutures. Wound well approximated. The use of. Patients who have not had at least three doses of a tetanus vaccine or who have an unknown tetanus vaccine history should also receive a tetanus immune globulin. 9. Stitches (also called sutures) are used to close cuts and wounds in the skin. Foam dressings are more absorptive but mostly used for chronically draining wounds. Not all areas of the body can be taped. Non-Parenteral Medication Administration, Chapter 7. Terri R Holmes, MD, Coauthor: Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. 11. 11. Glynda Rees Doyle and Jodie Anita McCutcheon, Clinical Procedures for Safer Patient Care, Continuous and Blanket Stitch Suture Removal, Creative Commons Attribution 4.0 International License. Tylenol or ibuprofen as needed for discomfort or fever > 102.5 Return if no improvement in 1,342 0 The loculations were broken up and the wound was explored. 17. VI. 5. For a video of suturing techniques, see https://www.youtube.com/watch?v=-ZWUgKiBxfk. Chapter 3. Using the principles of sterile technique,place Steri-Strips on location of every removed suture along incision line. Wound well approximated. Patients with a clean and minor wound should receive the tetanus vaccine only if they have not had a tetanus vaccine for more than 10 years. All sutures used for traumatic skin laceration repair are swaged (ie, the needle and suture are connected as a continuous unit). If the wound is well healed, all the sutures would be removed at the same time. When to Call a Doctor After Suture Removal. The body of the needle is the portion that is grasped by the needle holder during the procedure. These relatively painless steps are continued until the sutures have all been removed. Continue to keep the wound clean and dry. Autotexts. Competency Assessment A. If there are concerns, question the order and seek advice from the appropriate health care provider. Understanding the various skin-closure procedures and knowing how they are put in and what to expect when they are removed can help overcome much of this anxiety. 6. All wounds held together with staples require an assessment to ensure the wound is sufficiently healed to remove the staples. People with a tendency to form keloids should be closely monitored by the doctor. Think about how you can reduce waste but still ensure safety for the patient. A sample of such instructions includes: Different parts of the body require suture removal at varying times. Parenteral Medication Administration. Ensure proper body mechanics for yourself and create a comfortable position for the patient. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. This provides patient with a safe, comfortable place, and attends to pain needs as required. The patient was anesthetized. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes. Instruct patient to take showers rather than bathe. Patient information: See related handout on taking care of healing cuts. 20. The wound is cleaned with an antiseptic to remove encrusted blood and loosened scar tissue. Never snip both ends of the knot as there will be no way to remove the suture from below the surface. Copyright 2023 American Academy of Family Physicians. When removing staples, consider the length of time the staples have been in situ. Laceration of upper or lower eyelid skin can be repaired with 6-0 nylon sutures. Checklist 34 provides the steps for intermittent suture removal. This scarring extends beyond the original wound and tends to be darker than the normal skin. Remove dressing and inspect the wound using non-sterile gloves. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Topical agents commonly used in the United States include lidocaine/epinephrine/tetracaine and lidocaine/prilocaine. Wound care after suture removal is just as important as it was prior to removal of the stitches. Devitalized and necrotic tissue in a traumatic wound should be identified and removed to reduce risk of infection.4,5, If a foreign body (e.g., dirt particles, wood, glass) is suspected but cannot be identified visually, then radiography, ultrasonography, or computed tomography may be needed. Below are some good ones Ive come across. https://www.youtube.com/watch?v=-ZWUgKiBxfk, https://lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/. Local anesthetic with epinephrine in a concentration of 1:200,000 is safe for use on the nose and ears. Procedure Notes from Ventura Family Medicine:http://www.venturafamilymed.org/cerner-ehr-tips/autotexts/399/preoperative-risk-assessment-for-mace. Bite wounds with a high risk of infection, such as cat bites, deep puncture wounds, or wounds longer than 3 cm,43 should be treated with prophylactic amoxicillin/clavulanate (Augmentin).47,48 Clindamycin may be used in patients with a penicillin allergy.49, Physicians should use the smallest suture that will give sufficient strength to reapproximate and support the healing wound.50,51 Commonly used sutures are included in Table 250,51; however, good evidence is lacking regarding the appropriate suture size for laceration repair. See Additional Information. This is intended to be a repository for efficiency tools for use at VCMC. If there is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade. Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. 6. Disadvantages of using skin closure tapes include less precision in bringing wound edges together than suturing. Both CPT and the Centers for Medicare & Medicaid Services (CMS) consider suture removal to be part of a minor surgical procedure's global package. Position patient appropriately and create privacy for procedure. 2023 WebMD, Inc. All rights reserved. This is intended to be a repository for efficiency tools for use at VCMC. Remove dressing and inspect the wound. This picture was taken 1 week after his fall. Contact physician for further instructions. Position patient appropriately and create privacy for procedure. Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. 39 Skin can be repaired using staples; interrupted, mattress, or running sutures, such as. Only remove remaining sutures if wound is well approximated. At the time of suture removal, the wound has only regained about 5%-10% of its strength. Autotexts How-To Videos All Posts Encounter Notes Addiction Medicine Clinic Procedure Notes Hospital Women's Health Pediatrics Plans Staple removal is a simple procedure and is similar to suture removal. Sutures may be absorbent (dissolvable) or non-absorbent (must be removed). The patient should be referred to ophthalmology if the laceration involves the eye itself, the tarsal plate, or the eyelid margin, or penetrates deeper than the subcutaneous layer. 12. Cut Steri-Strips so that theyextend 1.5 to 2 inches on each side of incision. 1996-2023 WebMD, Inc. All rights reserved. Initial Competence 1. The wound appears improved to the patient. 2021 by Ventura County Medical Center Family Medicine Residency Program. Care and maintenance includes frequent dressing changes and attention to the peri-wound skin, which is at risk for breakdown in the presence of ++ moisture. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes. post-procedure bleeding. About one-third of foreign bodies may be missed on initial inspection.6. Remove remaining sutures on incision line if indicated. Debridement of facial wounds should be conservative because of increased blood supply to the face. Note the entry and exit points of the suture material. Procedure Notes CERNER EHR Welcome to our Cerner Tips & Tricks page. suture removal kit, dressing change tray, steri-strips (always follow your hospital's protocol when removing sutures because some facilities require you to wear sterile gloves.while others require you to just wear clean gloves.this video will demonstrate using sterile gloves.) 10. Lidocaine/prilocaine is not approved by the U.S. Food and Drug Administration for use on nonintact skin, although it has been used this way in numerous studies. Visually assess the wound for uniform closure of the wound edges, absence of drainage, redness, and swelling. Injured tissue also requires additional protection from sun's damaging ultraviolet rays for the next several months. Staples are made of stainless steel wire and provide strength for wound closure. Topical and injectable local anesthetics reduce pain during treatment of lacerations and may be used alone or in combination.2123 Topical anesthetics (eTable A) are particularly useful when treating children. Do not peel them off. Suture removal is determined by how well the wound has healed and the extent of the surgery. Observe the wound for signs and symptoms of infection and notify a healthcare professional if any concerns. Emotional trauma is best described as a psychological response to a deeply distressing or life-threatening experience. Tetanus prophylaxis should be provided if indicated. Aware of S&S of infection and to observe wound for same and report any concerns to the healthcare provider. Close-up of adhesive strips used to close the wound to the eyebrow. Staples were used to close the wound after the operation. to improve lung expansion after surgery (e.g., coughing, deep breathing). The staple backs out of the skin the very same direction in which it was placed. Importance of avoiding strain on the wound (i.e., if this is an abdominal wound, no straining during defecation; if this is a knee wound avoid kneeling). Betadine, an antiseptic solution, is used to cleanse the area around the wound. Learn how BCcampus supports open education and how you can access Pressbooks. They may require removal depending on where they are used, such as once a skin wound has healed. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. Wound infection: If signs of infection begin, such as redness, increasing pain, swelling, and fever, contact a doctor immediately. There are no significant studies to guide technique choice. endstream endobj 3 0 obj << /N 1 /Domain [ 0 1 ] /FunctionType 2 /C0 [ 0.12 ] /C1 [ 0.28 ] >> endobj 4 0 obj << /FontFile3 136 0 R /CapHeight 680 /Ascent 708 /Flags 262242 /ItalicAngle -13 /Descent -206 /XHeight 482 /FontName /Times-SemiboldItalic /FontBBox [ -167 -218 1025 919 ] /StemH 110 /Type /FontDescriptor /StemV 110 >> endobj 5 0 obj << /Name /ZaDb /Subtype /Type1 /BaseFont /ZapfDingbats /Type /Font >> endobj 6 0 obj << /Filter /FlateDecode /Length 700 >> stream Continue to remove every second staple to the end of the incision line. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. Allow small breaks during removal of staples. We are fullspectrum FamilyMedicine.Our graduates are empowered to serve with continuity of care in all settings, valuing all peoples. HtTn0#9JMsQ=D"y$I{67sx5._0)=MdLII+B^U+[Pp(%;n>^{-+B&>Ve4/I| PROCEDURE: The appropriate timeout was taken. Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Data source: BCIT, 2010c;Perry et al., 2014. However, there is no strong evidence that cleansing a wound increases healing or reduces infection.10 A Cochrane review and several RCTs support the use of potable tap water, as opposed to sterile saline, for wound irrigation.2,1013 To dilute the wounds bacterial load below the recommended 105 organisms per mL,14 50 to 100 mL of irrigation solution per 1 cm of wound length is needed.15 Optimal pressure for irrigation is around 5 to 8 psi.16 This can be achieved by using a 19-gauge needle with a 35-mL syringe or by placing the wound under a running faucet.16,17 Physicians should wear protective gear, such as a mask with shield, during irrigation. Grasp knot of suture with forceps and gently pull up knot. Clean incision site according to agency policy. Procedure Note: Universal precautions were observed. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. If tissue adhesive is misapplied, it should be wiped off quickly with dry gauze. Use of clean nonsterile examination gloves, rather than sterile gloves, during wound repair has little to no impact on rate of subsequent wound infection. Approximately 6 million patients present to emergency departments for laceration treatment every year.1 Although many patients seek care at emergency departments or urgent care centers, primary care physicians are an important resource for urgent laceration treatment. Which health care provider is responsible for assessing the wound prior to removing sutures. Apply Steri-Strips across open area and perpendicular to the wound. What is the purpose of applying Steri-Strips to the incision after removing sutures? After assessing the wound, decide if the wound is sufficiently healed to have the sutures removed. 5. It is within the RNs independent scope of practice to apply Steri-Strips to a wound without an order (BCCNP, 2019). Emergency & Essential Surgical Care Programme. Do not pull the contaminated suture (suture on top of the skin) through tissue. Then the needle with the thread attached is used to "sew" the edges of the wound together, in an effort to recreate the original appearance. For people with hypertrophic scars, a firm pressure dressing may aid in preventing them from forming. Data source: BCIT, 2010c;Perry et al., 2014. Position patient and lower bed to safe height; ensure patient is comfortable and free from pain. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 2.5 to 5 cm. Sutures are divided into two general categories, namely, absorbable and nonabsorbable. Removal of staples requires sterile technique and a staple extractor. Although patients have traditionally been instructed to keep wounds covered and dry for 24 hours, one study found that uncovering wounds for routine bathing within the first 12 hours after closure did not increase the risk of infection.58, A small prospective study showed that traumatic lacerations repaired with sutures had lower rates of infection when antibiotic ointment was applied rather than petroleum jelly. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. Continue cutting in the same manner until the entire suture is removed, inspecting the incision line during the procedure. This step reduces the risk of infection from microorganisms on the wound site or surrounding skin. Doctors use a special instrument called a staple remover. 20. These office-based procedures can diagnose questionable dermatologic lesions, including possible malignancies. This step reduces the risk of infection from microorganisms on the wound site or surrounding skin. Acki is discharged from the clinic following removal of sutures in his knee following a mountain biking accident. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. The redness and drainage from the wound is decreasing. Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient. The wound line must also be observed for separations during the process of suture removal. All Rights Reserved. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. Position patient, lower bed to safe height, andensure patient is comfortable and free from pain. The area surrounding the skin lesion was prepared and draped in the usual sterile manner. Contact physician for further instructions. This step allows for easy access to required supplies for the procedure. Mackay-Wiggan, J., et al. Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits. Suture removal is a process removing materials used to secure wound edges or body parts together from healed wound without damaging newly formed tissue The timing of suture removal depends on the shape, size and location of the sutured incision The sutures may be removed by the surgeons or by the surges regarding to the tropical customs. 14. Ventura County Medical CenterFamily Medicine Residency Program, 300 Hillmont Ave, Building 340, Ventura, CA 93003. 13. To remove intermittent sutures, hold scissors / blade in dominant hand and forceps in non-dominant hand. Place receptacle close to suture line; grasp scissors in dominant hand and forceps in non-dominant hand. Type of suture* Timing of suture removal (days) Arms: 4-0: 7 to 10: Face: 5-0 or . Checklist 39 outlines the steps to remove continuous and blanket stitch sutures. Author disclosure: No relevant financial affiliation. These occur mostly around joints. Search dates: April 2015 and January 5, 2017. What would you do next. Place lower tip of staple extractor beneath the staple. Cartilage has poor circulation and is prone to infection and necrosis. Using the principles of asepsis,place Steri-Strips perpendicular along the incision line with gaps of approximately 2 to 3 mm between each. PROCEDURE 130 Suture and Staple Removal Brian D. Schaad PURPOSE: Sutures and staples are placed to approximate tissues that have been separated. Inspection of incision line reduces the risk of separation of incision during procedure. If there are concerns, question the order and seek advice from the appropriate healthcare provider. circumstances may mean that practice diverges from this LOP. PROCEDURE: skin cleaned with wound cleanser skin cleaned with Hibiclens skin cleaned with Betadine skin cleaned w NS drain/packing removed closure material removed small amount of purulent . 6. Adapted from World Health Organization. Film dressings allow for visualization of the wound to monitor for signs of infection. Suture removal is determined by how well the wound has healed and the extent of the surgery. 1.2 Infection Prevention and Control Practices, 1.4 Additional Precautions and Personal Protective Equipment (PPE), 1.7 Surgical Hand Scrub, Applying Sterile Gloves and Preparing a Sterile Field, 2.5 Head-to-Toe / Systems Approach to Assessment, 2.6 Head-to-Toe Assessment: head and neck / Neurological Assessment, 2.7 Head-to-Toe Assessment: Chest / Respiratory Assessment, 2.8 Head-to-Toe Assessment: Cardiovascular Assessment, 2.9 Head-to-Toe Assessment: Abdominal / Gastrointestinal Assessment, 2.10 Head-to-Toe Assessment: Genitourinary Assessment, 2.11 Head-to-Toe Assessment: Musculoskeletal Assessment, 2.12 Head-to-Toe Assessment: Integument Assessment, 3.3 Risk Assessment for Safer Patient Handling, 3.7 Types of Patient Transfers: Transfers without Mechanical Assistive Devices, 3.8 Types of Patient Transfers: Transfers Using Mechanical Aids, 3.10 Assisting a Patient to Ambulate Using Assistive Devices, 4.3 Wound Infection and Risk of Wound Infection, 4.6 Advanced Wound Care: Wet to Moist Dressing, and Wound Irrigation and Packing, 6.3 Administering Medications by Mouth and Gastric Tube, 6.4 Administering Medications Rectally and Vaginally, 6.5 Instilling Eye, Ear, and Nose Medications, 7.2 Preparing Medications from Ampules and Vials, 7.6 Intravenous Medications by Direct IV (Formerly IV Push), 7.7 Administering IV Medication via Mini-Bag (Secondary Line) or Continuous Infusion, 7.8 IV Medications Adverse Events and Management of Adverse Reactions, 8.2 Intravenous Therapy: Guidelines and Potential Complications, 8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump), 8.7 Priming IV Tubing / Changing IV Bags / Changing IV Tubing, 8.8 Flushing and Locking PVAD-Short, Midlines, CVADs (PICCs, Percutaneous Non Hemodialysis Lines), 8.9 Removal of a PVAD-Short, Midline Catheter, Percutaneous Non Hemodialysis CVC, and PICC, 8.11 Transfusion of Blood and Blood Products, 10.2 Caring for Patients with Tubes and Devices, Appendix 2: Checklists - Summary and Links. The 3-0 sutures work well for the thicker skin on the back, scalp, palms, and soles.50,51, A meta-analysis of 19 studies of skin closure for surgical wounds and traumatic lacerations found no significant difference in cosmetic outcome, wound infection, or wound dehiscence between absorbable and nonabsorbable sutures.52,53 A systematic review did not show any advantage of monofilament sutures over braided sutures with regard to cosmetic outcome, wound infection, or wound dehiscence.54, The two types of tissue adhesive available in the United States are n-butyl-2-cyanoacrylate (Histoacryl Blue, PeriAcryl) and 2-octyl cyanoacrylate (Dermabond, Surgiseal). Clean techniques suffice if wounds have been exposed to the air and the wound is approximated and healing. Which healthcare provider is responsible for assessing the wound prior to removing sutures? Remove every second suture until the end of the incision line. These scars can be minimized by applying firm pressure to the wound during the healing process using sterile Steri-Strips or a dry sterile bandage. Steri-Strips applied. Alternate sutures (every second suture) are typically removed first, and the remaining sutures are removed once adequate approximation of the skin tissue is determined. A single bite with reverse cutting needle or tapered needle (6-0 polypropylene sutures) should be used to approximate skin and perichondrium simultaneously. 10. This is also a relatively painless procedure. Suture Type and Timing of Removal by Location; Suture Types: Absorbable vs. Nonabsorbable Sutures; Ultrasound; Other procedures of interest. Non-absorbent sutures are usually removed within 7 to 14 days. Never leave suture material below the surface. An antibiotic ointment (brand names are Polysporin or. 5. Depending on the type of wound, it may be reasonable to close even 18 or more hours after injury. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs. Next, the area is numbed with an anesthetic agent such as lidocaine (Xylocaine). Confirm patient ID using two patient identifiers (e.g., name and date of birth). Carefully cut and remove suture anchoring drain with sterile suture scissors or a sterile blade. Removing subcutaneous fat may lead to depression of the scar.38 Single layer 5-0 or 6-0 nylon sutures are sufficient.32. Cosmetic outcomes of facial wounds repaired without deep dermal sutures are similar to layered closure.37 The approach to repair varies by wound location. Prepare the sterile field and add necessary supplies (staple extractor). Cleaning also loosens and removes any dried blood or crusted exudate from the sutures and wound bed. There are several textbooks that are good to have in your clinic for easy review before procedures. All wounds form a scar and will take months to one year to completely heal. 8. Then soak them for removal. Once the wound is closed a topical antibiotic gel is often spread over the stitches and a bandage is initially applied to the wound. Wound becomes red, painful, with increasing pain, fever, drainage from wound. Confirm patient ID using two patient identifiers (e.g., name and date of birth). This allows easy access to required supplies for the procedure. Report any unusual findings or concerns to the appropriate healthcare professional. If the wound is well healed, all the sutures would be removed at the same time. Alternatively you can use no touch technique. 13. Hypertrophic scars are scars that are bulky but remain within the boundaries of the wound. However, scarring may be excessive when sutures are not removed promptly or left in place for a prolonged period of time. Common periods of time for removal are as follows, but times vary according to the health care professionals that perform the procedure: Sutures may be taken out all at one visit, or sometimes, they may be taken out over a period of days if the wound requires it. 13. This step reduces risk of infection from microorganisms on the wound site or surrounding skin. 12. Pat dry, do not scrub or rub the incision. Emergency and Trauma Care Module 2: Basic surgical skills:Practical suture techniques. They can be used in nearly every part of the body, internally and externally. Care should be taken to avoid getting tissue adhesive into the wound or accidentally adhering gauze or instruments to the wound. Tetanus immune globulin is not indicated for clean, minor wounds (Table 4).63. These sutures are used to close skin, external wounds, or to repair blood vessels, for example. What situations warrant staple / suture removal to be a sterile procedure? Keloid formation: A keloid is a large, firm mass of scarlike tissue. Early suture removal risks wound dehiscence; however, to decrease scarring and cross-hatching of facial sutures, half of the suture line (ie, every other suture) may be removed on day 3 and the remainder are removed on day 5. Therefore, protect the wound from . 2021 by Ventura County Medical Center Family Medicine Residency Program. They deny fevers or malaise. These changes may indicate the wound is infected. You are about to remove your patients abdominal incisionstaples according to the physicians orders. 3. Checklist 38 provides the steps for intermittent suture removal. Cleanse drain site: 10. 4,9,12-14 The types of sutures used to secure chest tubes vary according to the preference of the physician, the physician assistant, or the advanced practice nurse. After cleansing the wound, the doctor will gently back out each staple with the remover. Glynda Rees Doyle and Jodie Anita McCutcheon, Clinical Procedures for Safer Patient Care, Next: 4.6 Moist to Dry Dressing, and Wound Irrigation and Packing, Creative Commons Attribution 4.0 International License. Inspection of incision line reduces the risk of separation of incision during procedure. 1. The Steri-Strips will help keep the skin edges together. Non-absorbent sutures are usuallyremoved within 7 to 14 days. Staples are used on scalp lacerations and commonly used to close surgical wounds. 3. The rate of wound infection is less with adhesive strips than with stitches. The sterile2 x 2 gauze is a place to collect the removed suture pieces. These scars can be minimized by applying firm pressure to the wound during the healing process using sterile Steri-Strips or a dry sterile bandage. This is based on expert opinion and experience. If the galea is lacerated more than 0.5 cm it should be repaired with 2-0 or 3-0 absorbable sutures. Sutures should be removed after an appropriate interval depending on location (Table 535 ). Place a sterile 2 x 2 gauze close to the incision site. Position patient and lower bed to safe height; ensure patient is comfortable and free from pain. Report any unusual findings or concerns to the appropriate health care professional. Scarring may be more prominent if sutures are left in too long. Ear trauma often causes a hematoma, and applying a pressure dressing can be difficult. Scarring may be more prominent if sutures are left in too long. This allows for dexterity with suture removal. The doctor applies pressure to the handle, which bends the staple, causing it to straighten the ends of the staple so that it can easily be removed from the skin. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. 8-10 Wind the distal portion of the suture tightly around the digit in a closed spiral (Figure 101-2B). Therefore, protect the wound from injury during the next month. %ySDft9:%(JnC'+iSFGH}QVF EHpI): .;Zf4-Hb"fz|ZFPSfh{l\# o HZSR,4']-l!jZ#tig,};84cP. Data source: BCIT, 2010c; Perry et al., 2014. Snip second suture on the same side. Checklist 36 outlines the steps for removing staples from a wound. D48.5 Neoplasm of uncertain behavior of skin. If a person has received stitches, they should be given instructions for taking care of the stitches and wound, and be given an approximate date to have the stitches removed. Remove remaining staples, followed by applying Steri-Strips along the incision line. Allow the Steri-Strips to fall off naturally and gradually (usually takes one to threeweeks). When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor. 16. Slip the tip of the scissors under suture near the skin. Key words were skin laceration, skin repair, local anesthesia, sterile technique, sterile gloves, and wound irrigation.
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