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The Art of Wound Repair - Suturing for Physician Assistants and Nurse Practitioners July 14, 2010
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Bob Blumm, MA, PA-C, DFAAPA Past President, ACC About the Author
Bob Blumm, MA, PA-C, DFAAPA Past President, ACC

Wound repair is a necessary skill for all PAs and NPs and is usually placed into their training with the knowledge that there will be an extensive period of practical application as they continue their studies and move forward into rotations. Unfortunately, this is not the case across the board, and PAs and NPs graduate their programs and pass their boards without so much as learning to tie a square knot. This is unfortunate and places the new clinician at a disadvantage as wound repair is a necessary part of training and practice and, like other knowledge and skills, does not come from simply reading a book on wound repair or picking up an Ethicon suturing manual with a training aid and having the expectation that you will master this skill. To clinicians like myself, it represents one of our greatest opportunities to demonstrate our concern and our competence to our patients as well to demonstrate that wound repair with the appropriate suture for the appropriate wound is more than a skill but is an art. The art of suturing is the process of preparation, thinking, documentation, taking a good history and physical examination, immunizing our patient, delivering the proper type of local anesthesia, developing the attitude that creates a non threatening environment for the patient and the family members so that on a psychological basis we are healing two patients or more with the same approach and actions. I also discuss malpractice prevention techniques in all my lectures to help secure your future. The closure of a wound is my signature, something that this patient will wear for life and something that I am proud of and hope that they too will see as creative artwork on what would have been a defect. Suturing is fun!

I have been teaching basic and advanced suturing for Ethicon for about 25 years and it is my hope that every workshop will produce another team of clinicians that will feel “confident and competent.” That is how I start the class, with the promise that I will transform them from clinicians who have fear of this area and are apprehensive because of their weak background in training or lack of a good emergency rotation to a clinician who feels confident and competent that they will be able to approach their next patient with skills learned and practiced under assistance until they perform self practice at home and are ready for that first real nasty laceration. Prior to giving a workshop, I like to make a presentation on management of wounds in the acute care setting, a 2010 (or whatever year) EBM approach. This is not always possible because of the need of the conference CME committee to introduce enough funded lectures so that all will walk away feeling that the conference is worthwhile and will encourage others to come next year. I fully understand this and therefore I proceed to a 15 minute basic lecture giving some points on selection of materials and other education that I deem necessary and then we move forward to the workshop.

The standard workshop will be three hours in length with the utilization of a “pig’s foot, anesthesia tips, 4-0 nylon suture, a disposable stapler and Dermabond, as an introduction to the use of a bioadhesive in the care of lacerations. The participants will then learn the “keystone stitch” which is the simple suture. Upon learning this stitch, all others are similar and the course participants are well on their way to excellence. We will then move on two a running suture, a horizontal mattress suture, a vertical mattress suture, a half buried mattress suture, a corner stitch, a buried stitch and a running intracuticular stitch (I call this one the feel good suture) because this is what plastic surgeons close their wounds with when they desire no outside sutures. As the class progresses I can teach additional techniques based upon time and the skills of the particular group. There is a special stitch for punch biopsies that few people bother to teach, there is making an incision and removing a mole and then closing deeply and along the length of the incision, there is the removal of a “dog ear or sow’s ear” as well as advancement flaps. This is why some of these courses teach a basic and advanced class, although I discover some who go to an advanced class who have not mastered the basic sutures. 

This summer a new book will be coming out that has been edited by Adam singer, MD, Judd Hollander, MD and myself and will be the latest evidence based medicine textbook on the subject of wound repair in the urgent care setting. This book will have many physician, PA and NP contributing authors and will discuss every application of wound closure and the care and treatment of burns, animal and human bites, dressings, infections, adhesive tapes, bioadhesives, anesthesia, wound preparation and more. I mention this now to alert you to this opportunity early and to encourage your group to add the additional hour of training that I mentioned earlier. For those conferences that I am speaking at for the remainder of the year, I will add this lecture if there is a place or if a lecturer does not show for some reason, without cost to the organization because I feel it is that important.  

So, summer’s here and the organizations and associations will be giving you a much needed opportunity to learn new information and skills. I will be teaching at the GAPA conference, the summer AFPPA meeting in Washington, DC, the NPA conference at Lake George, the New Hampshire Academy conference in the fall as well as the annual super AFPPA conference in Colorado Springs. If any state PA or NP is looking for a workshop or other lectures, please contact me at surgblumm@gmail.com. I would love to add my knowledge and skills to making your conference just a bit better, if possible.





Robert M. Blumm
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award.  He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.





 The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


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Bob Blumm (Amityville, NY.) on 14 Apr 2014 at 9:40 pm

Next week the NCNP will be meeting in Chicago and there are two suturinfpg workshops there. I am assisting at bit and although not as extensive as an FHEA course, this will still be helpful.

Contact FHEA for information.

Bob

Bob Blumm (Amityville, NY) on 14 Apr 2014 at 1:27 pm

As in other responses, if you are an NP or PA and you require an extensive suturing class than there is nothing more helpful and challenging than the full day FHEA Suturing course that I give for Peg Fitzgerald. If you are in a state society or association or are a national association I can give a four hour course but you would require a buy in from your society/association as it requires numbers to make this financially successful for them. I am willing to help anyone but it requires the teamwork of you and your group whereas FHEA.com has done the thinking and planning for you and are the most rigid when using an instructor for an all day course. Both the participants and myself work for a lasting positive result. Bob Blumm

terry (illinois) on 14 Apr 2014 at 11:37 am

looking for a suturing class in illinois, indiana, st. louis area in next few months.

Bob Blumm (Amityville, NY) on 03 Mar 2014 at 7:23 pm

Go to the FHEA website as I am doing a six hour workshop in Atlanta for Peg Fitzgerald at the end of the month. We will have sixty students and three assistants and I will lead the course.

Becky Jones (Beaufort SC) on 03 Mar 2014 at 7:06 pm

Looking for a suturing class near South Carolina. I am a nurse practitioner

Bob Blumm (Amityville) on 09 Feb 2014 at 12:09 pm

Go to the FHEA website as it has five locations where I am giving an all day workshop with two lectures. It is the most complete course I give unless a state or national organization allows two lectures and a combined basic and advanced workshop.

Bob

Kristi (Texas) on 07 Feb 2014 at 7:16 pm

Hi. I'm a FNP working at an Urgent Care looking for skills lab on suturing. Do you have any coming up soon?

Anonymous (Indianapolis) on 10 Jan 2014 at 3:26 pm

Are there any classes you have planned for February - May? I could travel, but specifically indiana, ohio or Illinois?

Bob Blumm (Amityville,NY) on 18 Oct 2013 at 9:26 pm

I will be speaking for Ethicon at a Wound Closure Workshop in Jacksonville,Florida in November. This is a course with a couple if refresher sutures and then all the newest types of sutures that are knotless (Stratafix) and the new devices for adhesive closure, Dermabond Advance and Prineo. The course is almost four hours with a one hour didactic lecture and about 3 1/2 hrs of a workshop.

It's free, has a free meal depending on morning or evening and you need to contact your Ethicon Rep or professional education or sales manager to sign up and tell them "Bob Sent You"

Nicole (Ft. Lauderdale) on 18 Oct 2013 at 8:35 pm

Hello Bob,

Is South Florida on your upcoming schedule?

Thanks

Gaby (Miami, Fl) on 10 Oct 2013 at 12:19 pm

Are you currently doing training courses for suturing? I'm very interested in doing one. Thanks

lars aanning (yankton SD) on 11 Aug 2013 at 12:30 am

Remember: running sutures anchored with square knots are unreliable!!

Bob Blumm (Amityville, NY) on 28 Jul 2013 at 3:06 pm

Hi Sherry:

I give at least 30-40 courses for Ethicon during the year but they are Wound Closure Academies and are focused on the new products and devices that Ethicon has produced as well as Residents course in surgery where we cover new innovations and difficult wound closures for the ER where these residents are compelled to cover during their training. I also give the Fitzgerald Health Education Associates Sutre workshop which is six hours and the most complete lecture/workshop that I give. contact them at FHEA.Com

Neile Bush (Bryan, Tx) on 28 Jul 2013 at 2:47 pm

Is there a location that we can look at your upcoming courses? I would love the opportunity to take your suture class. Do you plan on teaching any classes in Texas?

Bob Blumm on 24 May 2013 at 9:22 am

I will be speaking in Jackson, Fla on June 20th for Ethicon and for the person who asked about the book, it was published two years ago and is on amazon.It is entitles: Skin and Soft Tissue Infections."

Sharon (Rhode island) on 23 May 2013 at 5:15 pm

Hello Bob,

Will you be having any suturing workshops in the New England area in the near future?

Carol K. (Panama City FL) on 31 Mar 2013 at 11:19 am

Hi, I completed my ARNP degree on-line, and have never had the opportunity to learn basic suturing techniques. Do you have any classes upcoming in Florida, Alabama or Georgia? If not, can you suggest what I can do to learn this very important aspect of my practice? Thanks

Bob Blumm (Amityville, NY) on 29 Dec 2012 at 8:08 am

I have no schedule of courses until an entity requests that I give a workshop. You can contact your state PA or NO or national headquarters as well as those of Urgent Care clinics and the Emergency Medicine Bootcamp and request they contact me. I place as many workshops on my schedule as time will allow. Thanks.

bob

rene esparza (Phoenix Az) on 29 Dec 2012 at 2:22 am

Hi when is your next suturing class in phoenix AZ?

Bob Blumm (Amityville, NY) on 11 Nov 2012 at 2:48 pm

The book was published and is on amazon in 2011 by singer, Hollander and Blumm. As far as all these lovley requests, I advise that you contact your Ethicon Representative and get together a group of 40-50 interdisciplinary folks who can all first assist which means CST-CFA's, CSA's, RNFA's, PAs and NPs as well as physicians. The Ethicon Professional Education Department would need to be contacted and they would provide the program for the people in the area if the numbers are there. If not, ask your state group to invite me for their conference as my fee is reasonable and they need to take care of transportation and one night's hotel stay. Hope that this is an adequate answer for you all.

Bob

J. Bacchus (Miami, Florida) on 11 Nov 2012 at 4:00 am

Do you offer courses in the MIami, Florida area?

Bob blumm on 16 Oct 2012 at 8:16 pm

I am giving this course some day this weekend, probably saturday at the NPA of NYS. check out their website. I was going to do one in Phoenix in three weeks but I broke my foot and my orthopedist was worried about a DVT if I could not flex my leg.

bob

Sharon Martino (Homestead, FL) on 16 Oct 2012 at 2:52 pm

Hello,

When will you be in the Miami area?

surgblumm on 30 Sep 2012 at 2:54 pm

Hopefully I sent you a personal e-mail as

I have done two courses in Chicago this past month. I am a clinician like yourself and practice medicine between my conferences which are totaling 20 per year. Contact me at my e-mail address as I am leaving Chicago today abut am speaking somewhere almost every week until December.

Bob

surgblumm@gmail.com

Amy Stralka-Larson (Cleveland, Ohio) on 28 Sep 2012 at 11:32 am

I would love to take your course. Will you be anywhere near the Cleveland are sometime soon? Where can I find your dates and locations? thanks.

Bob Blumm (Amityville, NY) on 11 Apr 2012 at 4:56 am

Hi Sherry:
Suturing is fun, it is an art and it remains your signature on someone's body for life. That signature can be graceful and almost unseen or can be like the mark of the beast as it distracts from one's natural features or beauty. My Internal Medicine PA is a young (32) y/o beautiful Irish lady with a cute impish smile. She sustained a laceration on her lip that went vertically through her vermillion line. The result , although performed by a plastic surgeon on call, was less than acceptable and now she has a telltale scar that distracts the onlooker although she remains cute. Each time I see her as a patient I cannot forget that we have an

obligation to do our best and to utilize the proper closure techniques and the best sutures and layered closure to achieve excellent results. The fact that you are no longer a neophyte and yet wish to improve reflects upon your excellence as a clinician. I always strive to do better than the week before.
Unfortunately, I am not speaking in Chicago again until September and the FHEA website can give you the date information. This will be an all day course and cover all basic and many advanced techniques, including flaps. If this is too long to wait perhaps you can speak to your Ethicon Representative, gather the newest information on their wound repair products and speak to your local PA and NP group to see if you can gather enough people where the Rep can request a three or four hour class for a larger amount of advanced practice clinicians as well as physicians. There are many medical as well as NP and PA schools in Chicago and they can arrange a meeting sooner. I will accommodate a request that is timely as I do surgery around my speaking dates. These participants can be from the surgery specialty or Urgent care, emergency Medicine and busy Family Practice offices that do laceration repair.

I wish you the best in this endeavor and in your career.
Warm regards,
bob

John Schick (Texas) on 10 Apr 2012 at 10:39 pm

Bob, did you ever publish the new book on suturing you were talking about (summer 2010)? I went to the Amazon web site and all they have is the book published in 2002 by Singer and Hollander. If so is this a very relevant book on suturing for today? Or will the new book you mentioned be coming out soon? Wish I could attend one of your courses on suturing but doesn't look like anything is scheduled in Texas in the near future.

Bob blumm (Amityville, NY) on 26 Jan 2012 at 6:49 am

I am giving an all day course for Fitzgerald Health EducationAssociates on April 26, in Chicago. Google flea and ask for the particulars as this course has two didactic lectures and the remainder is suturing techniques and hopefully how to use Dermabond as well as staples.
Bob Blumm

Rowena (New Jersey) on 26 Jan 2012 at 12:12 am

Can you email me your courses, dates, and locations please?

Joy (New Jersey) on 19 Nov 2011 at 10:08 am

Hi,

Are you planning for a workshop in NJ or NY soon? I'm really interested to take one.

Thanks

Carmen Morales-Board (Bakersfield, CA) on 11 Nov 2011 at 11:11 pm

Hi when is your next suturing class in Washington State?
thanks
CMB

Bob Blumm (Amityville, NY) on 10 Aug 2011 at 11:14 am

I am doing a workshop for the AFPPA tomorrow in Washington , DC and again in Monterrey for the same group in November. Check out the AFPPA website. I will be doing at least two courses for FHEA in 2012 and am giving a course in S.C. in Oct. I do about fifteen a year at different state or national meetings and can make myself available for a group when needed with advanced notice.
Bob

RICHARD EVANS (ARIZONA) on 09 Aug 2011 at 10:05 pm

COURSES AND DATES PLEASE

Bob blumm on 25 Jul 2010 at 11:27 am

I would love to help you. I'll be giving this workshop at the summer conference of AFPPA in Washington, DC and the fall conference in Colorado springs.

Bob

sherry lynch (illinois) on 22 Jul 2010 at 2:23 pm

i would love to take this course. i was expected to suture with expertise when i started my first position. it was very stressful and now over the last year i have become much more skilled but would love some extra training. please respond.

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