CHAPTER 41: Wound Closure

Question 1

Wound is immediately closed by approximating its edges; main advantage being a reduction in healing time

Answer 1

Primary wound closure

Question 2

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

Answer 2

Secondary wound closure

Question 3

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

Answer 3

Delayed/Tertiary wound closure (Delayed primary closure)

Question 4

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

Answer 4

Sutures

Question 5

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

Answer 5

Staples

Question 6

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

Answer 6

Tissue adhesives

Question 7

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

Answer 7

Adhesive tapes

Question 8

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

Answer 8

Hair apposition

Question 9

TRUE or FALSE?
Simple (<2 cm) uncomplicated hand and finger lacerations where the wound edges approximate with little tension do not require primary closure

Answer 9

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

Question 10

Are the strongest of all the closure devices and allow the most accurate approximation of the wound edges

Answer 10

Sutures

Question 11

Nonabsorbable sutures retain their tensile strength for at least —?— days

Answer 11

At least 60 days

Question 12

Suture preferred for nonabsorbable use due to their strength, handling, and relatively low tissue reactivity, synthetic monofilament material

Answer 12

Nylon or Polypropylene

Question 13

Nonabsorbable less distensible sutures, cannot expand, and instead may lacerate the wound edges as the tissue swells

Answer 13

Nylon or Polypropylene

Question 14

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

Answer 14

Polybutester

Question 15

Nonabsorbable Suture Characteristics (Table 41-2 page 273)

Significant inflammatory reaction

Answer 15

Silk

Question 16

Nonabsorbable Suture Characteristics (Table 41-2 page 273)

Least inflammatory reaction

Answer 16

Polypropylene (Prolene®, Surgipro®)

Question 17

Absorbable sutures lose most of their tensile strength in less than —?— days

Answer 17

Less than 60 days

Question 18

Absorbable suture that has handling characteristics similar to nonabsorbable sutures (such as nylon); useful for intradermal or subcuticular closure; rapid absorption

Answer 18

Poliglecaprone 25

Question 19

Antibacterial agent incorporated in some absorbable sutures

Answer 19

Triclosan

Question 20

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

Answer 20

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

Question 21

Hemostasis is best achieved by —?—

Answer 21

Direct pressure

Question 22

Number of knot ties should correspond to the —?—

Answer 22

Suture size

Question 23

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

Answer 23

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

Question 24

Cyanoacrylate tissue adhesives sloughs off in —?— days

Answer 24

5 to 10 days as the skin renews itself

Question 25

TRUE or FALSE?

Butyl-cyanoacrylate is generally stronger and more flexible than octyl-cyanoacrylate

Answer 25

FALSE
Octyl-cyanoacrylate is generally stronger and more flexible than butyl-cyanoacrylate allowing its use on irregular surfaces and long lacerations

Question 26

The tissue adhesive should cover the entire wound and extend —?— mm on either side of the wound edges

Answer 26

5 to 10 mm

a single layer applied and dry for 30 to 45 secs

Question 27

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

Answer 27

Contraindications to hair apposition closure

Question 28

Butyl-Cyanoacrylate are limited to incisions and lacerations up to —?— cm

Answer 28

8 cm

Comparison of Butyl- and Octyl-Cyanoacrylate (Table 41-6 page 283)