Summary of key points for OSCEs

Indications and contraindications

Indications

Contraindications

Wound closure
Fixing drains in place, e.g.
chest drains, drains
sited intraoperatively
Repair of deep structures,
e.g. tendons

Patient refusal
Foreign matter in the wound,
including glass, dirt, etc.

Site

Suture and size

Time to removal

Scalp

7 days

Infected wound

Face

Large wound whose ends

cannot be suitably apposed
without significant tension

Chest wall

Non-absorbable
3/0
Non-absorbable
5/06/0
Non-absorbable
3/0
Non-absorbable
4/05/0
Absorbable
6/0

Limbs and hands

Lips/tongue/mouth

There are some situations where alternative wound

closure methods would be more appropriate. For
example, glue may be used on facial wounds or for
children; Steri-Strips may provide a useful and less
painful alternative.
Certain wounds may need specialist referral (e.g. to
a plastics centre), and simple closure methods are
inappropriate.

45 days
10 days
10 days
n/a

Choice of local anaesthetic

Lidocaine is the first choice of local anaesthetic agent
as it has a reasonably quick onset and relatively short
duration of action. The alternative is bupivacaine (Marcaine), which has a longer onset of action but is more
dangerous in terms of toxicity.

Types of suture
Choosing the appropriate suture material is important.
Suture material can be broadly classified as absorbable
or non-absorbable.
Type of material

Absorbable

Non-absorbable

Properties

Dissolve

Examples

Monocryl
Vicryl
Polydiaxonone (PDS)
No

Remain in situ
until removed
Nylon
Silk
Prolene
Yes, timing
depends on site
Limbs, face, neck,
abdominal/
chest wall

Removal required?
Suitable sites

Lips, mouth, tongue,

viscera

Suture needles come in a variety of shapes, including

circular, semi-circular, three-eighths of a circle, fiveeighths of a circle, straight, compound curved, half
curved, etc. You do not need a detailed knowledge of
these differences for the exam, but it is likely that you
will get a curved needle to use and be asked to demonstrate that you can close a wound without actually
touching the needle with your hands, i.e. using only
forceps and a needle holder.

The maximum safe dose of local anaesthetic depends

on a patients body weight. For lidocaine it is 3 mg/kg,
and with adrenaline it is 5mg/kg as its absorption is
less. For bupivacaine it is 2mg/kg. One may give as
much local anaesthetic as required as long as it does not
exceed these maximum doses.
If a larger volume is required to cover a wider area,
a greater volume of a more dilute concentration is sufficient to achieve the same effect. If no dilute preparations are available, dilute your local anaesthetic with
saline to the desired volume.
Local anaesthetic does not work as effectively in
infected tissue.

Suturing technique
The following should be considered:
Local anaesthetic infiltration, from around the perimeter of the wound inwards, including corners and angles