Primary wound closure

Question 1

What are the 3 vascular layers of the skin?

Answer 1

1. Superficial or subpapillary
2. Middle or cutaneous
3. Deep or subdermal/subcutaneous

Question 2

What is a cutaneous angiosome?

Answer 2

A region of skin supplied by a direct perforating cutaneous artery

Question 3

What are the primary differences between the vascular supply to the skin in the dog and cat?

Answer 3

The dog has greater collateral subcutaneous vasculature, the cat also has a smaller number and wider distribution of cutaneous perforating arteries.

Question 4

What are the different classifications of wound healing?

Answer 4

1. Primary closure or first intention healing.
2. Delayed primary closure: 2-5 days after wounding, before granulation tissue.
3. Secondary closure: after granulation tissue.
4. Second intention healing.

Question 5

What is the rate of reepithelialization in a closed wound?

Answer 5

1mm/d. This may create an epithelial seal within 24-48 hours.

Question 6

What is the strength of wounded skin at 14 days, 3-4 weeks, and several months post-op?

Answer 6

14 days: 5-10%
3-4 weeks: 25%
Several months: 70-80%

Question 7

What are the primary differences between cats and dogs when it comes to wound healing?

Answer 7

Cats had half the wound strength at 7 days compared to dogs, cats had decreased perfusion at 7 days, open cat wounds seem to heal more by contraction around the wound edges as compared to central pull in dog wounds

Question 8

How does removal of the subcutaneous tissues effect wound healing?

Answer 8

Reduced perfusion. Interestingly no change in healing in primarily closed wounds in 1 study

Question 9

What are some factors that may influence wound healing?

Answer 9

Tension, motion, self-mutilation, patient health (inflammation, age, malnutrition)

Question 10

How does age impact wound healing?

Answer 10

Geriatric patients have decreased cutaneous perfusion, increased skin fragility and increased infection risk

Question 11

Is scalpel incision or electrocautery or laser preferred for skin incision in dogs and cats?

Answer 11

Unclear. Scalpel shown to have increased wound strength compared to electrocautery at 10-14 days in experimental study. Human review demonstrated less pain when electrocautery used. Char is a consideration with electrocautery and laser

Question 12

What is the golden period in wound healing?

Answer 12

3-6 hours, which is considered the time taken for bacteria to proliferate to 10 to the 5 per gram

Question 13

Describe the relative knot security of various sutures commonly used in closure

Answer 13

Question 14

What are two suture patterns that can be used to correct small dog ears?

Answer 14

Apex cutaneous suture or dermal oblique horizontal mattress