Kapitel 75 - Primary wound closure

Question 1

1. Which of the following statements are true?

A. In primarily closed wounds with ideal apposition of subcutaneous tissues, the dermis and the epidermis, healing may occur simply by reepitheliazation at a rate of approximately 1mm/48hr

B. Wounded skin is only 5-10% as strong as normal unincised skin at 14 days after surgery; 25% as strong after 3-4 weeks and reaches 70-80% of ultimate strength after several months.

Answer 1

A false (1mm/24hr), B true

Question 2

Name 5 factors influencing wound healing

Answer 2

Tension
Pressure
Motion
Self-mutilation
Patient Health

Question 3

Which statements are/is true
A. For 3-0 polyglactin 910 three to six knots give adequate knot security and for polyglecarpone at least 4 throws are necessary for adequate knot security.

B. The Aberdeen (chain stitch) placed at the end of a continuous pattern had greater relative knot security and less volume.

Answer 3

A and B are true

Question 4

Below the dermis lies the hypodermis, or subcutaneous tissue, which is often rich in adipose and loose connective tissue. The vascular supply is separated into which three divisions?

Answer 4

• The superficial or subpapillary plexus
• The middle or cutaneous plexus
• The deep subdermal or subcutaneous plexus

Question 5

Different types of suture material have a different loss of tensile strength. What is the amount of loss in tensile strength (in percentages) in 14 days for the following suture materials;

A. Polyglactin 910 (Vicryl)
B. Polydioxanone (PDS)
C. Polyglyconate (Maxon)
D. Braided Lactomer (Polysorb)
E. Polyglecaprone 25 (monocryl)

Answer 5

A. 25%
B. 20%
C. 25%
D. 37%
E. 60%

Question 6

Name 6 common cutaneous suture patterns

Answer 6

1. Simple interrupted
2. Simple continuous
3. Interrupted cruciate
4. Continous cruciate
5. Continous Lock
6. Interrupted horizontal matress
7. Interrupted vertical matress

Question 7

Dog ears can be an esthetic problem when closing skin. Name two techniques preventing dog ears

Answer 7

Apex cutaneous sutures and horizontal oblique dermal sutures has been described for correction of small dog ears in wounds 2 cm or smaller.

Question 8

Descibe the apex cutaneous suture.

Answer 8

The apex cutaneous suture is a dermal sutures to correct small dog ears of wounds 2 cm or smaller, escecially aound the lips and cheeks. Non absorbable sutures are used. The needle is passed through the epidermis ca 3-4 mm away from the wound edge, towards the appex of the dog ear, then rediercted and out the opposite side to the original suture entrance.

Other techniques to prevent/correct dog ears:
1. Fudgin technique. Sutures are farther apart on the longer side of the wound.

2. Suturing by the rule of halves