II. Indications
- Hemostasis in an actively bleeding Skin Wound (e.g. Scalp Laceration, Finger Wound Hemostasis)
III. Precautions
- Exercise caution for injury to surrounding structures (risk of destructive compression to local nerves and larger vessels)
IV. Technique
- Preparation
- Clean and prepare the site (e.g. Chlorhexidine)
- Suture kit (e.g. large-bore Suture, forceps, needle driver)
- Identify maximal site of Hemorrhage
- Apply manual pressure to bleeding site with one finger, and shift finger position until bleeding is controlled
- Attempt to map the suspected vessel's course by applying manual pressure proximal to bleeding site
- Inject Local Anesthetic
- Lidocaine 1% with Epinephrine
-
Suture
- Estimate depth of suspected vessel (Suture passes should reach this depth for adequate Hemostasis)
- Pass needle through tissue 5-10 mm to one side of the suspected vessel, and parallel to its mapped course
- Repeat a second needle pass, parallel to the first pass, and on the opposite side of the vessel
- Tighten
- Slowly increase Suture tension until Hemostasis is achieved, and then apply a small amount of additional tension
- Gradual, adequate tension (contrast with maximal tension) reduces risk of local injury to adjacent structures
- Hemostasis is achieved
-
Hemostasis is NOT achieved
- Re-map the suspected vessel to ensure Sutures will be parallel its course
- Repeat suturing with an increased depth, tighten and tie Suture if Hemostasis is achieved
- See Skin Hemorrhage Management
- Consider alternative source of Hemorrhage (e.g. a second bleeding vessel)
V. Complications: Risks
- Failed Hemostasis
- Infection
- Local structure injury
- Needle injury
- Compression (e.g. adjacent nerves)
- Local ischemia (necrosis risk)
VI. References
- Warrington (2026) Crit Dec Emerg Med 40(8): 23-4