7: skin and fascial wound closure

Question 1

How does incorporation of the peritoneum into the closure of the abdominal wall contribute to closure

Answer 1

Increase in adhesion formation, not strength
causes inflammation
don’t suture this!

Question 2

Advantages of continuous suture patterns

Answer 2

decreased surgery time
Decrease suture material
similar dehiscence as interrupted

Question 3

Disadvantages of continuous

Answer 3

one break breaks it all

Question 4

Holding layers of fascia

Answer 4

linea alba

rectus abdominus fascia

Question 5

What direction do you want your lines to run during incision

Answer 5

parallel to lines of tension

Question 6

General skin closure rules

Answer 6

sharp instruments
parallel lines
maintain tissue hydration
avoid grasping skin

Question 7

Skin closure has how many layers

Answer 7

2
Subcuticular
skin

Question 8

Subcutaneous suture techniques

Answer 8

Interrupted or continuous
avoid adipose tissue
5-10mm bites

Question 9

Suture material for subq

Answer 9

non-reactive absorbable
small diameter
PDS, Vicryl, Maxon, Monocryl

Question 10

Skin closure pattern

Answer 10

Cruciate

simple interrupted

Question 11

Cutaneous suture types

Answer 11

monofilament
reverse cutting needle
nylon, prolene, fluorofil

Question 12

When do you use intradermal pattern for skin closure

Answer 12

clean wound
healthy patient
minimal to no lesion
mass removal or spay

Question 13

Suture material for intradermal

Answer 13

absorbable
vicryl, PDS, monocryl
small diameter
reverse cutting needle