Tendon Suture

Tendons are relatively avascular structures and heal by the in growth of connective tissue from the epitenon.

Indications

• traumatic injury to tendons
• as part of another procedure

Assessment

• Wounds in the vicinity of a tendon, assume tendon injury until it is shown to be intact on clinical examination
• If no action is demonstrated and there is doubt, explore the wound 

Small bowel resection and anastomosis

Indications

• Congenital lesions i.e.: atresia, duplication
• Traumatic perforation
• Critical ischaemia
• Crohn’s disease or other cause of stricture
• Tumours of the bowel or its mesentery

Preparation

• Adequate hydration and nasogastric intubation
• Appropriate prophylactic antibiotics

Skin suturing

Contra-indications

• Risk of infection is high (e.g. dog bites, heavily contaminated wounds, gun shot injuries)
• Risk of dehiscence is high due to ischaemia  (high tissue tension)

 Methods of approximation

• Sutures
• Staples
• Sterile plasters (steri strips)
• Tissue glue