CHAPTER 41: Wound Closure Flashcards
Wound is immediately closed by approximating its edges; main advantage being a reduction in healing time
Primary wound closure
Wound is left open and allowed to close on its own; relatively slow and uncomfortable and leaves a larger scar
Use: highly contaminated or infected wounds & in patients at high risk of infection
Secondary wound closure
Wound is initially cleansed and then packed with moist sterile gauze covered by a sterile covering; left undisturbed unless signs of infection develop; after 4 to 5 days dressing is removed, and wound edges can be closed
Use: highly contaminated wounds and animal bites
Delayed/Tertiary wound closure (Delayed primary closure)
Advantages and Disadvantages of Wound Closure Techniques (Table 41-1 page 272)
Adv: Greatest tensile strength; Lowest dehiscence rate
Dis: Greatest tissue reactivity; Highest cost; Slowest application
Sutures
Advantages and Disadvantages of Wound Closure Techniques (Table 41-1 page 272)
Adv: Low tissue reactivity; Low risk of needle stick
Dis: Less meticulous closure
Staples
Advantages and Disadvantages of Wound Closure Techniques (Table 41-1 page 272)
Adv: Resistant to bacterial growth; Resistant to bacterial growth; Microbial barrier; Occlusive dressing
Dis: Lower tensile strength than 5-0 or greater sutures; Dehiscence over high-tension areas (joints); Not useful on hands; Cannot bathe or swim
Tissue adhesives
Advantages and Disadvantages of Wound Closure Techniques (Table 41-1 page 272)
Adv: Least reactive; Lowest infection rates
Dis: Frequently fall off; Lower tensile strength than sutures or tissue adhesives; Highest rate of dehiscence; Cannot be used in areas with hair; Cannot get wet
Adhesive tapes
Advantages and Disadvantages of Wound Closure Techniques (Table 41-1 page 272)
Adv: Simple; Low cost; No foreign body placed in wound
Dis: Only for scalp; Only approximate simple nongaping lacerations
Hair apposition
TRUE or FALSE?
Simple (<2 cm) uncomplicated hand and finger lacerations where the wound edges approximate with little tension do not require primary closure
TRUE Simple (<2 cm) uncomplicated hand and finger lacerations, when treated with antibiotic ointment and gauze dressing, heal as fast and with no notable differences in appearance or function as those closed primarily with sutures
Are the strongest of all the closure devices and allow the most accurate approximation of the wound edges
Sutures
Nonabsorbable sutures retain their tensile strength for at least —?— days
At least 60 days
Suture preferred for nonabsorbable use due to their strength, handling, and relatively low tissue reactivity, synthetic monofilament material
Nylon or Polypropylene
Nonabsorbable less distensible sutures, cannot expand, and instead may lacerate the wound edges as the tissue swells
Nylon or Polypropylene
Nonabsorbable suture that have ability to elongate in response to external forces and possess elasticity to return to the original size once the load is removed. Hence useful in wounds where swelling is anticipated
Polybutester
Nonabsorbable Suture Characteristics (Table 41-2 page 273)
Significant inflammatory reaction
Silk
Nonabsorbable Suture Characteristics (Table 41-2 page 273)
Least inflammatory reaction
Polypropylene (Prolene®, Surgipro®)
Absorbable sutures lose most of their tensile strength in less than —?— days
Less than 60 days
Absorbable suture that has handling characteristics similar to nonabsorbable sutures (such as nylon); useful for intradermal or subcuticular closure; rapid absorption
Poliglecaprone 25
Antibacterial agent incorporated in some absorbable sutures
Triclosan
TRUE or FALSE?
Nonabsorbable sutures are useful for skin closure in children who are not candidates for wound repair with skin tapes or tissue adhesives
FALSE
Absorbable sutures, such as rapidly absorbing gut, are especially useful for skin closure in children who are not candidates for wound repair with skin tapes or tissue adhesives
Hemostasis is best achieved by —?—
Direct pressure
Number of knot ties should correspond to the —?—
Suture size
TRUE or FALSE?
The cosmetic results and dehiscence rates after closure of small superficial facial lacerations with tapes are similar to those with cyanoacrylate tissue adhesives
TRUE
The cosmetic results and dehiscence rates after closure of small (<4 cm) and superficial facial lacerations with tapes are similar to those with cyanoacrylate tissue adhesives
Cyanoacrylate tissue adhesives sloughs off in —?— days
5 to 10 days as the skin renews itself
TRUE or FALSE?
Butyl-cyanoacrylate is generally stronger and more flexible than octyl-cyanoacrylate
FALSE
Octyl-cyanoacrylate is generally stronger and more flexible than butyl-cyanoacrylate allowing its use on irregular surfaces and long lacerations
The tissue adhesive should cover the entire wound and extend —?— mm on either side of the wound edges
5 to 10 mm
a single layer applied and dry for 30 to 45 secs
Long lacerations (e.g., >10 cm)
Grossly contaminated wounds
Uncontrolled bleeding
Wounds that gape open and cannot be closed w/out significant tension
Hair strands adjacent to the wound that are less than 3 cm in length
Contraindications to hair apposition closure
Butyl-Cyanoacrylate are limited to incisions and lacerations up to —?— cm
8 cm
Comparison of Butyl- and Octyl-Cyanoacrylate (Table 41-6 page 283)
