Proper placement of the anesthesia should result
in a loss of sensitivity in a few minutes. This is
tested by asking the patient if he or she can
distinguish a sharp sensation or pain when a sharp
object is gently applied to the skin.
Obtaining local anesthesia is similar except you
are anesthetizing nerves immediately adjacent to
where you will be working and not nerve trunks.
There are two generally accepted methods of in-
filtrating the anesthesia. One is through the skin
surrounding the margin of the wound and the
other is through the wound into the surrounding
tissue. In either case, sufficient quantities must
be infiltrated to effect anesthesia approximately
1/2 inch around the wound, taking care not to
inject into a vein or artery.
A note of caution: The maximum recom-
mended amount of Xylocaine to be used is 50 cc
for a 1 percent solution or the equivalent.
General Principles of Wound Suturing
Wounds are closed either primarily or secon-
darily. A primary closure is within a short time
of when the wound occurred; a secondary closure
is a delayed closure for up to several days. In
general, wounds less than 6 hours old can be
closed without the danger of infection. Wounds
6 to 14 hours old may be closed if they are not
grossly contaminated and are meticulously
cleaned. Wounds 14 to 24 hours old should not
be closed primarily. When reddening and edema
of the wound margins, discharge of pus, persis-
tent fever, or toxemia are present, do not close
the wound. Do not close primarily a large, gap-
ing, soft tissue wound. This type of wound is cer-
tain to contain large quantities of bacteria. These
wounds will require warm wet dressings and ir-
rigations, along with aseptic care for 3 to 7 days
to clear up the wound. Then a delayed wound
closure may be performed.
Debride the wound area and convert cir-
cular wounds to elliptical ones before
suturing. Circular wounds cannot be closed
with satisfactory cosmetic result.
Try to convert a jagged laceration to one
with smooth edges before suturing it. Make
sure that not too much skin is trimmed off
that would make the wound difficult to
Use the correct technique for placing
sutures. The needle holder is applied at ap-
proximately one quarter of the distance
from the blunt end of the needle. Suturing
with a curved needle is done toward the
person doing the suturing. Insert the needle
into the skin at a 90 degree angle and sweep
it through an arclike motion, following the
general arc of the needle.
Carefully avoid bruising the skin edges be-
ing sutured. Use Adson forceps and very
lightly grasp the skin edges. It is improper
to use dressing forceps while suturing.
Since there are no teeth on the grasping
edges of the dressing forceps, the force re-
quired to hold the skin firmly may be
enough to cause necrosis.
Do not put sutures in too tightly. Gentle
approximation of the skin is all that is
necessary. Remember that postoperative
edema will occur in and about the wound,
making sutures tighter. See figure 4-50.
If there is a significant chance that the
sutured wound may become infected (e.g.,
bites, delayed closure, grossly con-
taminated), place a small iodoform or
rubber drain in the wound and remove it
in 48 hours.
When suturing, the best cosmetic effect is
obtained by using numerous interrupted
simple sutures placed 1/8 inch apart.