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Echoes from the Suture Workshops March 20, 2011
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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

I am fortunate enough to present close to 20 Suturing Workshops at national and State meetings of PAs and NPs. The longer an instructor teaches a course the more pliable they become and develop an attitude of listening to the comments, questions and insights of the course participants. I always tell the participants that they will leave the course confident and competent. The ration for a successful course in no more than 15:1 with 12:1 being the most ideal. This is encouraged in order to give each student the time they require. This means that among the board or committees I usually will need one or, at the most, two assistants as we are giving person-to-person instruction. The assistants in these programs are sophisticated enough to have had a number of years of experience in suture techniques and if they are learning a new technique, they will quickly be able to absorb it, practice it once and help a participant. I am also delighted that some of the participants are far better than they think, are not suturing virgins and have the ability to do some of the techniques perfectly and are utilized to help a slower student. We try to teach at least 8 techniques in a three hour session which includes 45 minutes of didactic education for the purpose of explaining the different types, techniques, materials, local injections, documentation, TD and other aspects. I like to have a general session when the situation lends itself to it, for a general audience lecture on Care of lacerations and wounds: An evidence based perspective as this is so important to all NPs and PAs to  know the high points of documentation and care  which can prevent major problems. I co-authored and co-edited a book in November of 2010 entitled Skin and Soft Tissue Injuries and Infections along with Adam singer MD and Judd Hollander MD. We have many PAs, NPs and physicians who were contributing authors which means this is a balanced book and the most current excellent source for people practicing in emergency medicine, urgent care medicine, family practice, the military and occupational medicine. This book is meant for all of the clinicians listed above and will be the most important addition to your library. It can be purchased on, is with many of the booksellers at meetings and is carried at Peg Fitzgerald’s meetings.

The participants have suggested that we add injection techniques and when to use different types of local anesthesia. This is now an early portion of the workshop. We utilize sutures, staples, Steri-strips and skin adhesives to have a well balanced knowledge that will be utilized according to the situation. When asked which technique or type of material is the best I can only say; the one that meets the need of the hour. We don’t staple eyes or put skin adhesive on mucosa, we cannot tape over hair and sutures do not need to be utilized on all cases.  This means that there are times that no local anesthesia is needed and therefore the patient suffers no discomfort. Skin adhesives do not require office visits for removal whereas staples require a staple remover.  The acquisition of the knowledge of techniques is important as some a better than others and a neat and healed wound or laceration is your personal signature. I take this business seriously as competence in every aspect of patient care enhances our reputations both as a profession and as personal clinicians. Ego is best served when the aftermath is a happy and health patient. My ego is involved in patient care as I push myself to do the best I can on every patient which gives me personal satisfaction.  Our students are taught the need to undermine some wounds, prevent and treat infection, handle instrumentation properly, learn the “plastic surgical stitch” (a running subcuticular or intracuticular suture that I call the ‘feel good stitch”) as a participant realizes that one does not need to be a plastic surgeon to achieve a closure that is every bit as excellent. Some of our workshops are designed to be lengthier and the last one that I taught for Dr. Peg Fitzgerald was an all day course incorporating two didactic lectures and the remainder in learning many techniques including flaps. All students are taught the technique of closing a wound in its depth using a subcutaneous suture to both take the tension off of the wound as well as to approximate it so that a skin adhesive can be utilized with our getting between the skin margins. I will do one follow up article on this subject as all of the comments are not addressed and there should be an explanation concerning some of these techniques.

If your national, state or large group wishes to have programs at their conference please contact me at and we can discuss your needs and all other relevant information.

Bob 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 23 Mar 2011 at 11:49 am

I am resending this because I see it on my computer. I would love to speak at the Michigan Academy of PAs or NPs whatever the case may be and give this 3 hour suture workshop. As promised, in addition I will give a 45 minute or slightly more for NPs who usually ask for additional time, a free lecture on "Caring doe LAcerations and Wounds in the ER, Urgent Care and Primary Care." You will have the responsibility Katrina of contacting your Academy leader( CME) Chair and see if they have room on the schedule. I remain their servant but will need to know in time to add to my calendar. Let them contact me at my e-mail

bob Blumm (amityville, NY) on 23 Mar 2011 at 11:37 am

I would gladly be a suture workshop speaker at the Michigan Academy of PAs or NPs , whatever the situation may be. My class is three hours and since this would be the first time speaking here I would do another lecture free on Caring for Lacerations and Wounds in the ER, Urgent care and Primary Care: Evidence Based for 2011.
The CME Chair can contact me at and we can work out the details. This will place you in the pivotal position Katrina. You need to speak to your academy leaders.

Katrina (Port Huron MI) on 23 Mar 2011 at 4:38 am

Are you offering a class here in Michigan?

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