Wound Care Answers 515Staples(c)do not give the desired cosmesis for a facial wound repair.
Staples are more appropriate for scalp laceration. Steri-Strips (d)can be used
in very small skin openings with minimal tension. They will not provide the
tensile strength required for this patient’s wound closure. (b)Dermabond
would be inadequate for use in this laceration which crosses the hairline.
Lastly, shaving surrounding hair (a)increases the risk of infection and therefore
not recommended. Of note, eyebrows should not be shaved because of the
high likelihood that eyebrows will not regrow.
464.The answer is d.(Rosen, pp 741-743.)Application of a lidocaine
digital blockat the base of the finger will block the digital nerves allowing
for appropriate anesthesia. The needle is inserted into the web space on
either side and anesthesia is deposited anteriorly and posteriorly. This is
repeated on the opposite side of the affected digit.
Local infiltration and digital block (c and e)with lidocaine and epineph-
rine is incorrect as epinephrine is contraindicated in areas of end organ circu-
lation (tip of nose, glans penis, scrotum, ears, nose, and fingers). Irrigating
(a)a wound with anesthetic does not provide adequate anesthesia. Although
local infiltration (b)will provide adequate anesthesia, it may interfere with
good wound approximation and therefore may lead to a poor cosmetic result.
465.The answer is e.(Tintinalli, pp 298-299.)Choosing a suture material is
based on tissue type, tissue tension, and whether or not sutures will require
removal. Oral mucosa is rapidly healing and under moderate tension. Addi-
tionally, because the inner lip mucosa does not require a cosmetic result,
absorbable sutures should be used. Therefore, absorbable chromic gutis the
best suture choice. A 5-0 chromic gutwill provide sufficient tensile strength
to match that of the oral mucosa.
(d)A 1-0 chromic gut is unnecessarily large. Oral mucosa does not require
the tensile strength provided by a 1-0 suture and would leave an uncom-
fortably large knot mass. (c)Absorbable monofilament sutures provide more
tensile strength than necessary in this case and are preferred for closure of deep
structures (eg, fascia). Nylon sutures (a and b)are not the best choice for oral cav-
ity repairs because they would require the patient to return for removal.
466.The answer is b.(Tintinalli, pp 328-331.)Suture removal is a balance
between cosmetic outcome and adequate wound closure. Increasing suture