75. Primary wound closure

Question 1

types of wound closure

Answer 1

1. primary closure (first intention): immediate closure (incision)2. delayed primary: closed BEFORE GT3. secondary closure: closed AFTER GT4. 2nd intention healing: wound heals without suturing

Question 2

vascular supply to the skin

Answer 2

1. superficial or subpapillary plexus2. middle or cutaneous plexus3. deep, sub dermal or subcutaneous plexus

Question 3

species difference dog vs cat in terms of skin blood supply

Answer 3

dog–greater density of collateral subcutaneous vessels in the trunk regioncat–smaller number and wider distribution of cutaneous perforatorscats had lower cutaneous perfusion 7 days post op but no difference in 14 dayscats have lower wound breaking strength at 7 days (poor healers)

Question 4

re-epithelialization rate

Answer 4

1 mm/day

Question 5

wounded skin strength 14 days post op

Answer 5

5-10%only reaches 70-80% several months later

Question 6

T/Fclose parallel to tension lines

Answer 6

TRUE

Question 7

amount of char that will penetrate peripheral skin with radio waves, CO2 laser and electrocautery

Answer 7

0.1-0.3 mm

Question 8

T/Fin dogs, incisions made with sharp dissection with blade had approximately 2x the wound strength at 10-12 days post op compared to incisions made with electrocautery

Answer 8

TRUEalso had less drainage and had faster, stronger healing

Question 9

“golden period” for wounds

Answer 9

<6 hoursbefore bacterial count is greater than 10^5 CFU/gram of tissuecan consider primary closure of fresh clean or clean/contaminated wounds

Question 10

polyglactin 910 vs polyglecaprone 25 in intradermal closure

Answer 10

polyglactin 910(Vicryl) vs polyglecaprone 25 (monocryl)significantly more incisional swelling and redness with polyglactin 910 in EARLY wound healingno difference later

Question 11

beginning continuous pattern–knot recommendations

Answer 11

3 throws for polyglycolic acid (Dexon), polyglactin 901 (vicryl) and polypropylene 4 throws chromic gut5 throws polydiaxanone (PDS) and nylon

Question 12

ending continuous pattern–knot recommendations

Answer 12

5 throws chronic gut, polyglycolic acid (Dexon), polypropylene6 throws polyglactin 901 (vicryl), nylon7 throws polydiaxanone (PDS)

Question 13

wound strength 1 days after surgery for an incision closed with minimal suture and tissue adhesive vs an incision closed with nylon skin sutures alone

Answer 13

tissue adhesive group had a wound strength 15% as strong as incision closed with nylon suture aloneNOT recommended for sutures under tension and avoid contact with SQ tissues

Question 14

techniques for getting rid of dog ears

Answer 14

1. apex cutaneous suture or horizontal oblique dermal suture (if < 2cm)2. remove two small triangles3. remove one large triangle4. remove arrowhead and close in a Y5. remove ellipse around dog ear6. Half Z correctionin humans, may regress if < 8mm in height

Question 15

techniques to fix a step defect

Answer 15

1. manipulate the suture knot to other side2. place suture at same depth on both sides of wound3. half buried horizontal mattress with intradermal portion on “low side”4. place stiff untied suture from superficial high side to deep on the low side

Question 16

T/FNSAIDS have been shown to effect ion incisional healing

Answer 16

FALSENSAIDs tested appear to have no effect on incisional healing in dogs.