To Stitch or Not to Stitch Soft Tissue Wounds in Hockey Jeffrey R. Brown, MD Stephanie Kramer, DO, Chris Lonegan, DO

Transcription

1 To Stitch or Not to Stitch Soft Tissue Wounds in Hockey Jeffrey R. Brown, MD Stephanie Kramer, DO, Chris Lonegan, DO Director of Primary Care Sports Medicine, CSMI Trinity Health Of New England Medical Group Team Physician, Central CT State University Team Physician, University of Hartford

2 Disclosure Slide No financial relationships to disclose

3 Goals Today: Focus on soft tissue lacerations 4 methods of closure Demos Review specific Cases How would you close this wound?

4 How should we close a laceration? Steri-Strips Tissue Adhesive (i.e. Dermabond) Sutures Staples Photos: courtesy of Jeff Anderson, MD & Google images

5 Steri-Strips Advantages Quick and easy Good for superficial closures Virtually Painless Easily replaced by patient Inexpensive Well-tolerated Disadvantages Falls off easily Not indicated for moderate or deep lacs Can t get wet Often Requires reapplication

6 Tissue Adhesive Advantages Topical use Quick application Less pain no lidocaine needed Acts as own dressing No topical abx needed Water resistant Outcomes = 5.0/6.0 suture repairs Sloughs off in 7-10 days Disadvantages Topical use only Superficial closure only Short <6-8cm Low-tension <0.5cm gap Clean-edged Don t cross joints or creases Only Linear/curvilinear lac Can t get soaked If infected remove it

7 Tissue Adhesive Wounds not suitable for adhesive:

8 Suture closure Advantages Most Versatile Any length Any tension strong Can close deep wounds and uneven wounds/jagged edges Can cross joints & creases If infected wound, can remove some sutures, leave others Disadvantages Need to use anesthetic/lidocaine Takes longer to complete Needs dressing usually Avoid getting wet Needs to be removed

9 Staples Advantages Quick placement 3-4 x faster than sutures Works well w/bloody wound Strong Can use in areas hard to suture Vs. sutures Associated with: Lower tissue reaction Easy to remove 1 or 2 if infection occurs Can get wet Disadvantages Superficial closure only Need 2 people for best results one approximates/everts skin edges w/forceps Usually need to use anesthetic/lidocaine Needs dressing usually Needs to be removed

10 The Cases Stephanie Kramer, DO, Chris Lonegan, DO

11 10 yo hockey player has the game of his life. After the game while showering he slips backwards onto his head against the shower tiles.

12 32 yo hockey player attempts to punch an opposing player in a fight and misses but ends up grazing his forearm against the mask of the opposing players helmet.

13 14 yo hockey player gets placed in penalty box. In a fit of rage he takes his helmet off and slams his head back against the penalty box wall.

14 45 yo M hockey player falls to the ground and is skated over by the blade of an opposing team member.

15 26 year old female accidentally hit in the lip by a skate after she fell on the ice

16 5 year old Mite skater tripped on their bag while leaving the locker room and hit their forehead on a bench

17 12 year old player accidentally caught their ear while removing their helmet after a game.

18 17 year old male was fooling around with his teammates and caught his forearm on a skate hook.

19 6 yo female hockey player is practicing pond hockey with a friend and takes a puck off of the upper eyelid without a helmet present.

20 35 yo hockey player gets skate blade across left cheek

21 16 yo female hockey player accidentally gets hit by her friend s stick on the underside of her chin.

22 60 yo hockey referee accidentally slides her newly sharpened skates across her shin while getting ready for a game.

23 22 year old male was hit in the head with a stick after his helmet came off during a fight.

24 35 year old male accidentally caught his arm on a sharp edge of the board during a line change

25 14 year old male was kicked through his sock by a teammate who forgot he still had a skate guard on one skate and fell

26 College hockey player was hit in the face by a swordfish thrown on the ice after he scored a hat trick

27 Thank you!