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When should you place deep sutures? Think about them if there is skin tension (or it’s anticipated). Do you ever undermine a wound? A nifty tension reliever for that gaping lac.
We have recently started using the Zip Surgical Skin Closure Device in our ED. I would love to hear thoughts on this system from the contributors.
Hi Michael! What's been your experience with this method. I'm on the website checking it out and it looks very quick to apply (which could be a huge win with a long lac!)
Hi Rob! I used this device a couple of times on my last shift. I used it on a small, simple forehead laceration in a 2 year old. It took less than 2 minutes and the wound closed beautifully. Also, there was no need to restrain or sedate the child and there was no pain for the child. What usually takes 30 minutes and at least three people was literally over in a couple of minutes and I did not need any additional help. My only concern (especially in young is children) is durability compared to traditional sutures.
Thanks for sharing your experience. I had heard of this device but personally haven't had a chance to get my hands on it. It is hard to evaluate your concerns about durability in an evidence-based fashion as the company has only published pre-clinical, feasibility studies (with promising results) and have yet to publish their post-marketing data (which is where the problems are often identified).
Having reviewed their product website and application videos, I guess my big question is regarding how much advantage this really confers over other cheaper adhesive closure methods like steri-strips. They point out that it is better equipped to withstand dynamic tension forces (such as over the crease of a knee after a total knee arthroplasty) but this type of lac is less common in the ED. Further, the device appears to be better suited for long, straight lacs without macerated or abraded edges. Thus, there are a significant portion of ED lacs that we see that I think wouldn't fit the bill.
If you get follow up on your patient, let us know!
I was wondering if there was any more information on the set back suture technique? Videos, etc. Thanks!
Thanks for your question! This one minute video I created explains the technique: https://youtu.be/KoP-4HT9iDg
You can read about the technique in detail in Dr. Kantor's text, "Atlas of Suturing Techniques: Approaches to Surgical Wound, Laceration, and Cosmetic Closure."
Forthcoming, I will publish a short blog post on this technique and its applications in Emergency Medicine at www.lacerationrepair.com.
What you do matters.