A protocol on how to stitch up a wound OSCE style

1. C. Riedinger 1
Surgical knot notes
Surgical knot – 5 min station
Task:
- Impersonate medical student on ward
- Deal with actor wearing suture pads and act as if he/she is a real patient
- Explain to the examiner what you are doing
Procedure:
- introduce self, gain consent and co-operation
- take history:
o what happened
o how long since incident?
o Change of contamination?
o Last tetanus shot?
- Explain that wound should be clean before starting
- Collects and prepares equipment
o Sterile field box
o Needle + sutures, two types:
Braided (for practise) and nylon (absorbable)
o Needle-holder scissors and normal scissors
o Toothed and un-toothed forceps (toothed are better for viable tissue as
they don’t squeeze the tissue so much, use un-toothed for removing
contaminants only)
o Sterile gloves
o Lidocaine syringe and syringe heads
o SHARPS BIN
- Perform hand hygine and put on sterile gloves QuickTime™see this picture.
are needed to and a
decompressor
- Examine the wound for
o Evidence of infection
o Neurovascular state
o Tendon function (important to test otherwise may snap later)
o Inspect depth, length and site of wound
o Contamination
- Use 1% lidocaine syringe to anaesthetise wound edges
o Use yellow or blue needle to inject
o If there is risk of hitting a vessel, aspirate back
o Inject parallel to cut and pull back while injecting
- Dispose of syringe in sharps bin
- Holds needle correctly in holder as shown above (1/3 away from thread with
needle at 90*)
- Support wound edge with toothed forceps
- Pass needle through each side of the wound (not both sides with one stroke)
and pull through an appropriate length of thread
- Tie the knot effectively, no too tight, not too loose:
o 2 rolls forwards, grab tip of tail and roll off/pull
o 1 roll backwards, slide off
o 2 rolls forwards, slide off
- cut the threads at an appropriate length to the knot
- maintain good aseptic technique throughout
- dispose of sharps and leave area clean and tidy
- give patient advice card on how to look after their stitches (depending on the
location, the sutures remain in the wound for a different number of days)
- check patient’s tetanus status

2. C. Riedinger 2
Surgical knot notes
- record in notes how many sutures inserted
Removal of sutures:
- recall from notes the number of sutures put in
- introduce self, gain consent and co-operation
- perform hand hygiene blabla
- assemble equipment:
o sterile gloves
o suture cutter
o forceps
- put on sterile gloves
- use aseptic technique
- inspect wound:
o healing
o inflammation
o infection
- note the correct position to cut
- lift up suture with forceps
- hold stitch cutter and slide under the suture to cut it on the correct side so that
the piece of thread overlying the suture is not cut through the wound
- remove one or two sutures (alternating) and reassess
- if not healed enough, seal with steristrips and wait for one week before trying
again
- dispose of sharps
- record number of sutures removed in notes
- hand hygiene
- leave clinical area tidy
Steristrip notes:
- start in the middle of the wound
- cover one side of cut and then pull aross
- leave 3mm spaces in-between
- apply dressing
- also check tetanus status