Dr. Joel Aronowitz — Plastic Surgery Repair of Emergency Elbow Laceration with Suturing Tips
Dr. Joel Aronowitz: “We do a little acute laceration that occurred last night in an elderly gentleman, very thin skin. As we age, the dermis of our skin that gives it its strength, thins and we also lose some of the elasticity of the skin because the protein elastin is more deficient in aged skin. Sun damage over the years contributes to that but also the loss of testosterone, the loss of human growth hormone and age causes an attenuation or stretching out of the dermis and that gives the dermis less ability to resist a sheer force which is a rubbing kind of a force. The strength of the skin is overcome, the skin simply ruptures and tears and that’s with this kind of a laceration. So come with me, we’ll go have a look at it and we should be all set up to do the repair. So, this happened in the fall last night, right, and your daughter just called and I spoke to her and this is the main reason that if you get to choose you should always have at least one, preferably two daughters no matter how many sons you have because the sons are going to be like, yeah whatever, but the daughter is going to be looking out for you. Okay, so you can see the wound and the skin is, it looks like there’s not enough skin. Okay so now we’re going to do a little local anesthesia here and just if we inject through the wound itself it’ll be less painful, just a little bit at a time so we minimize the extension caused by the local and we let it diffuse by itself and it’ll cause less pain. When was your last tetanus shot, do you know? No.”
Client: “Okay.”
Dr. Joel Aronowitz: “Who is his, let’s see, we’ll call his internal medicine doctor and ask.”
Client: “Okay.”
Dr. Joel Aronowitz: “So first thing we’ll do is just unfurl this skin back. Clean that little bit of hematoma. There we go. And now that will be a lot easier to repair.”
Client: “Okay.”
Dr. Joel Aronowitz: “This is a simple running stitch. I’m putting in simple stitches as opposed to mattress sutures and it’s running meaning, I’m not putting a knot after each stitch, just letting it continue and there’s some advantages and disadvantages of that. One advantage is it can be faster, another advantage is that it spreads the tension out evenly if you do it properly. But if it’s too tight then the whole suture line will be too tight and if you don’t tie it properly or secure it properly what will happen is you’ve lost your whole suture line which is generally not good. You see how I’m stretching it out as I go so that that helps me line up the edges of the laceration properly as we go around a curve here. And now. You notice even though it’s oozing a little bit, oozing will stop pretty soon once I get the skin edges together and I’ll check and make sure there’s no hematoma underneath. And you notice I’m picking up the needle with my fingers sometimes because that way if I avoid picking it up with the needle holder it’s my sharpness of my stitch is going to be preserved. Now I’m going to go back on myself. So instead of going from down up I’m going from up down so I have the in and out on the same side here. So let me just show you that because that’s a little trick at the end of the stitch that allows the knot to be straight across. So you see now this way when I tie this knot it comes down nicely straight across and not at an angle otherwise if I didn’t do that it would come down on an angle and distort the end of my repair. And we want to put at least four knots in proline so it doesn’t come unraveled. And we’ll take a look at what we’ve done and see if we’re happy with it. And what will we do if we’re not happy with-it Austin? Redo it. So here’s our repairs complete now and we’re going to dress this. And we’ll dress this as soon as that last little bit of oozing stops and then we’ll see you back in 48 hours. She’ll keep it dry until then okay. So, here’s our repair and now we’re going to wrap him and we’ll see him back in about 48 hours. We’ll have him keep it completely dry for us until then.”
Originally published at https://drjoelaronowitzmd.blogspot.com on February 15, 2024.
