Chapter 1: Skin Repair and Minor Plastic Surgery

PRINCIPLES OF REPAIR OF EXCISIONAL WOUNDS

It is important to keep the following in mind:¹

1. Plan all excisions carefully.

2. Check previous scars for healing properties.

3. Aim to keep incision lines parallel to natural skin lines.

4. Take care in poor healing areas, such as backs, calves and knees; and in areas prone to hypertrophic scarring, such as over the sternum of the chest, and the shoulder.

5. Use atraumatic tissue-handling techniques.

6. Practise minimal handling of wound edges.

7. Use Steri-Strips™ after the sutures are removed.

GLOVES

The use of gloves for these procedures is advisable; ideally sterile gloves but a landmark study (Heal et al.) demonstrated that sterile gloves have no advantage over non-sterile clean boxed gloves.²

WOUNDS AND SUTURING

Suturing is a fundamental and important skill for which patients may judge the performance quality of their practitioner. This skill involves the appropriate method of treating a wound. Small superficial cuts heal well if debrided and cleaned with a suitable antiseptic such as chlorhexidine, and covered with a clean adhesive dressing.

PRACTISING SUTURING

Appropriate materials:

• peaches—skin mimics children’s skin

• grapes—mimics delicate skin

• butcher’s offerings—pig’s trotters, chicken breast, beef tongue, chicken trachea.

TAPING WOUNDS

The use of wound closure tape (e.g. Steri-Strips) for smaller clean wounds is to be encouraged (Fig. 1.1). Children may not tolerate repair of wounds with local anaesthetic and suturing, so appropriate closure with tape after disinfection and drying is recommended—as is the use of their hair for scalp wounds (Chapter 15). Primary sutures should be avoided in contaminated or severely contused wounds, especially if there has been a delay of 4 hours or more before repair. Such wounds should be cleaned, trimmed and a dry dressing applied. They can then undergo primary suturing on the fifth day.

Steri-Strips

These adhesive strips are ideal for smaller clean cut wounds, which should first be disinfected and dried.

Method

1. It is usual to start in the centre of the wound.

2. Render the strip taut and straight with a finger on either side of the strip as it is placed over the wound (Fig. 1.1).

3. Lock it in place then repeat with a series of strips at appropriate intervals. The strips can be bolstered by applying a cross-strip parallel to the wound.

   Steri-Strips can also be used to supplement a sutured wound.

How long

They are usually worn until they fall off or are removed in 5 to 7 days.