Basic wound suturing (model)
PLAB 2 & PRES 3 · practical skills / surgery · medium · 8 minutes
Candidate brief
You are an FY2 doctor in the emergency department. Ms Chloe Bennett, 26, cut her left forearm on a kitchen knife two hours ago. The wound is 4 cm long, clean, and has stopped bleeding. A wound pad/model is provided for suturing. Before you suture, assess the wound clinically with the patient. Then suture the wound on the model, verbalising each step — including your anaesthetic dose calculation — as you perform it.
What examiners look for
In wound stations, the examination is the assessment, not the sewing. Examiners award the early marks for mechanism, tetanus, contamination, and the tendon–nerve–vessel check. A chef who cannot flex a finger has a hand-surgery referral, not a suture station — and the candidate who checks first is the one who notices. Dose maths must be audible. Maximum dose of plain lidocaine is 3 mg/kg (7 mg/kg with adrenaline); 1% solution contains 10 mg/ml. Saying "60 kilos, so 180 milligrams, so up to 18 ml — I'll use about 6" is what safe prescribing sounds like out loud. Eversion heals flat. Wound edges closed slightly everted settle to a level scar as they heal; edges that invert or are strangled by over-tight knots heal as ridges, grooves or worse. Approximate, never strangulate: if the edges blanch, the knot is too tight. Sharps rules are choreography: the needle lives in the needle holder or in the sharps bin, nowhere else — never resheathed, never handed across, never parked on the pad "for a second". Needlestick injuries happen in the gaps between those rules. Removal timing is site-specific and is always examined: face about 3–5 days, scalp 7–10, trunk and limbs 7–10, over joints 10–14. Sending a forearm patient away without a removal plan converts a finished procedure into an unfinished episode of care. Aftercare is safety-netting, not small talk: what infection looks like, when to come back, and what to do about work. For a chef, the food-hygiene conversation about a sutured wound is not pedantry — it is the difference between her wound and her customers' problem.
Guideline references
- https://geekymedics.com/simple-interrupted-suture-osce-guide/
- https://www.nhs.uk/conditions/cuts-and-grazes/
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