5 – Principles of Wound Closure Flashcards
1
Q
What are the 3 types of wound closure?
A
- Primary wound closure: surgical incisions
- Delayed primary closure: resolve infection, achieve debridement, BEFORE granulation
- Secondary closure: AFTER granulation tissue
2
Q
What are the advantages of primary wound closure?
A
- Optimal function
- Best cosmetics
- Shortest healing time
3
Q
What do you need to consider when deciding to do a primary closure?
A
- Location
- Regional blood supply
- Tissue loss
- $$ for the clients
- Extension of infection
4
Q
What are wounds suitable for primary closure?
A
- Surgical incisions
- Lacerations within golden period (less than 8 hrs)
- Ex. fresh eyelid laceration (within golden period, healthy tissue)
5
Q
What are wounds NOT suitable for primary closure (reasons for failure)?
A
- *Tension
- Motion
- Deviated tissue
- Heavily contaminated (Ex. infection)
6
Q
What are some considerations related to primary closure technique?
A
- Is anatomic reconstruction necessary? (ex. if lots of skin is lost or dead)
- Tension free coaptation (can we help facilitate the process?)
- Non-surgical wound=avoid braided suture
7
Q
How can you manage tension?
A
- Tension relieving sutures
- Tissue undermining
- Tension relieving incisions
- Plasty procedures
- Pre-suturing
8
Q
What are some tension relieving sutures?
A
- Near-far-far-near
- Vertical mattress: stented
o *decreases vascular compromise - Horizontal mattress: stented
o *risk for VASCULAR COMPRISE TO CUT SURFACE - *stented: anything you can run suture through to disperse the pressure over a greater surface area (example button or tubing)
9
Q
What is tissue undermining?
A
- Place scissor under skin and open them to SPREAD subcutaneous tissues
o *makes it more mobile - Downsides:
o Creating dead space=can place a drain or stab incisions
o Compromising the blood supply
10
Q
What are tension relieving incisions?
A
- Stab incisions that need to go full thickness skin
- *if create enough on either side of cut surface=can pull edges closure together
- Will also be drain holes (Ex. if did undermining)
11
Q
What are plasty procedures?
A
- Ex. Z-plasty
- Can work with line of tension to change from horizontal to vertical and flipping the into a different position
- *do it beside your cut surface to allow you to pull the tissue closure together
- **works well on thinner skin (dogs, cats, and some areas in horses, NOT cows)
12
Q
What is pre-suturing?
A
- Place big sutures (large mattress sutures)
- Leave for 4-8 hours
- *stress relaxes the skin
o NOT developing new tissue, but allowing collagen in skin to STRETCH (tissue expanders=get new skin to develop, don’t use often)
13
Q
What is delayed primary closure?
A
- Resolve infection
- Achieve debridement
- *before granulation tissue: day 0-1 (granulation tissue days 3-5)
- **success dependent on
o Resolution of infection
o Tension managed closure - Under utilized: more in hospital or clinical settings
14
Q
Order for delayed primary closure
A
- Day one: debride
- Day two: clean
- Day three: repair
15
Q
What is secondary closure?
A
- After granulation tissue is present
- Sharp excision
- Undermining
- Tension sutures
o Maybe use a stent bandage: can change it often without need to do more sutures (have pre-placed loss sutures)
- Tension sutures
- *otherwise similar principles
16
Q
What are advantages of secondary closure?
A
- Allows resolution of infection
- Host debridement
17
Q
What are some disadvantages of secondary closure?
A
- Tissue is less manipulative
- Need to do tension relieving techniques (tissue undermining, relief incisions, tension relieving sutures)
18
Q
What are some alternatives to closure?
A
- Second intention (no suturing=just let it heal)
- Skin grafts
- flaps
