Methods of Wound Closure

Question 1

Primary closure

Answer 1

Clean wound, usually surgically created or following minor trauma
Standard suturing methods will usually suffice
Wound heals by primary intention

Question 2

Delayed primary closure

Answer 2

Similar methods of actual closure to primary closure

May be used in situations where primary closure is either not achievable or not advisable e.g. infection

Question 3

Vacuum assisted closure

Answer 3

Uses negative pressure therapy to facilitate wound closure
Sponge is inserted into wound cavity and then negative pressure applied
Advantages include removal of exudate and versatility
Disadvantages include cost and risk of fistulation if used incorrectly on sites such as bowel

Question 4

Split thickness skin grafts

Answer 4

Superficial dermis removed with Watson knife or dermatome (commonly from thigh)
Remaining epithelium regenerates from dermal appendages
Coverage may be increased by meshing

Question 5

Full thickness skin grafts

Answer 5

Whole dermal thickness is removed
Sub dermal fat is then removed and graft placed over donor site
Better cosmesis and flexibility at recipient site
Donor site morbidity

Question 6

Flaps

Answer 6

Viable tissue with a blood supply
May be pedicled or free
Pedicled flaps are more reliable, but limited in range
Free flaps have greater range but carry greater risk of breakdown as they require vascular anastomosis