This is a list of pearls and pitfalls that I share with the medical students and interns to whom I teach suturing and wound closure techniques. I can’t tell you how many pigs feet I have seen in my lifetime. Feel free to use and add to the list.

10. Assume that all wounds have a foreign body in them.
9. Assume that no one will take out sutures or staples unless you tell them to. Don’t forget discharge instructions for suture or staple removal. Scalp staples in for 6 months = bad.
8. Irrigation occurs AFTER local anesthesia (not before). Ouch.
7. Don’t forget to irrigate! “The key to pollution is dilution.”
6. Don’t forget to perform a neurologic exam before instilling anesthetic.
5. Assume that all tissue adhesives are purposely designed to run directly towards areas that you don’t want, such as the eye.
4. Don’t forget to clean up all sharps and used equipment when done.
3. When finished, take an extra few seconds to apply a nice bandage.
2. Assume that all wounds will get cellulitis, especially of the hands and feet. Be sure to warn patients of what to look for.
1. Assume all patients will “syncopize” during the procedure. Usually it’s a 300-lb person who will fall directly on little ol’ you while you are anesthetizing or irrigating a wound. Seat patients in a gurney with their legs up.


Michelle Lin, MD
ALiEM Editor-in-Chief
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls
Michelle Lin, MD