Primary wound closure

Question 1

What is delayed primary closure?

Answer 1

where you resolve the infection and achieve debridement and closure before granulation tissue

Question 2

What is secondary closure?

Answer 2

closure after granulation tissue

Question 3

What is secondary closure?

Answer 3

closure after granulation tissue

Question 4

what is primary wound closure?

Answer 4

closure of a surgical incision (or fresh wound?)

Question 5

What are the advantages of primary wound closure?

Answer 5

1. optimal function
2. best cosmetics
3. shortest healing time
4. usually earliest return to function

Question 6

When is primary wound closure used?

Answer 6

1. surgical incisions

2. lacerations–e.g. acute open tendon sheaths,

Question 7

How can anatomic location affect the closure choice?

Answer 7

1. the head has little motion and good blood supply
2. the body also reponds fairly well
3. the limbs may not have enough tissue to close an more motion. can also get more tissue loss

Question 8

What are issues with wounds on the limbs?

Answer 8

1. high movement
2. poor vascular supply
3. tissue loss

Question 9

What are three reasons why wounds should not be closed?

Answer 9

1. tension
2. motion
3. tissue considerations

Question 10

What is the #1 reason not to do primary wound closure?

Answer 10

tension

Question 11

What is the #2 reason not to do primary wound closure?

Answer 11

motion

Question 12

If there is a lot of movement with wounds, what can happen?

Answer 12

(besides pulling apart)

they can pull air into the wound

Question 13

What are three things to do with primary wound closure?

Answer 13

1. anatomic reconstruction
2. tension free coaptation
3. in nonsurgical wounds avoid braided suture

Question 14

What are three things to do with primary wound closure?

Answer 14

1. anatomic reconstruction
2. tension free coaptation
3. in nonsurgical wounds avoid braided suture

Question 15

What are three reasons for failure of primary wound closure?

Answer 15

1. tension
2. devitalized tissue
3. infection

Question 16

What are 5 ways to manage tension?

Answer 16

1. tension relieving sutures
2. tissue undermining
3. tension relieving sutures
4. plasty procedures
5. pre-suturing

Question 17

What are tension relieving sutures?

Answer 17

1. near-far-far-near
2. vertical mattress
3. stented vertical mattress
4. horizontal mattress
5. stented horizontal mattress

Question 18

Why is a near-far-far-near a useful tension relieving suture?

Answer 18

because it is an appositional pattern, and the suture material only has to be half as strong (pulley system)

Question 19

How is vettical mattress used as a tension relieving pattern?

Answer 19

by interspersing it with simple interrupted pattern

Question 20

Why may you use a stented vertical mattress?

Answer 20

if there is a lot of tension-used to resist cutting into the tissue. can sue IV tubing

Question 21

What is a problem with using the horizontal mattress as a tension relieving suture?

Answer 21

it causes vascular compromize

Question 22

What does tissue undermining do?

Answer 22

it makes hte skin more mobile

Question 23

How do avoid compromizing the vascular supply to the skin while undermining it?

Answer 23

stick to the subQ space

Question 24

What are tension relieving incisions?

Answer 24

They are stagger stab incisions which open up when the large wound is closed?

Question 25

What are plasty procedures?

Answer 25

cuts made in the skin to move flaps to different locations to close a wound

Question 26

What are the features of presuturing?

Answer 26

1. use large mattress sutures, typically vertical mattress. pull the skin across. Leave for 4-8 hours and the stress relaxes the skin

Question 27

When is pre-suturing most often used?

Answer 27

When want to remove a mass

Question 28

What can be some negative consequences of failure of a primary wound closure?

Answer 28

1. client money 2. tissue loss 3. extension of infection

Question 29

What can be some negative consequences of failure of a primary wound closure?

Answer 29

1. client money 2. tissue loss 3. extension of infection

Question 30

When is closure performed for delayed primary closure?

Answer 30

After resolution of infection and debridement and before granulation tissue days3-5

Question 31

The success of delayed primary closure depends on what?

Answer 31

1. resolution of infection | 2. tension managed closure

Question 32

What are the advantaes of secondary closure?

Answer 32

1. allows resolution of the infection | 2. host debridement of tissue

Question 33

What is the disadvantage of secondary closure?

Answer 33

1. tissue is less manibulative (more fibrous skin margins, difficult to get tension relief)

Question 34

What are tissue relieving techniques used in secondary closure?

Answer 34

1. tissue undermining 2. relief incisions 3. tension relieving sutures

Question 35

What are alternatives to clsoure?

Answer 35

1. second intention (open wound) 2. skin grafts 3. flaps

Question 36

What are alternatives to closure?

Answer 36

1. second intention (open wound) 2. skin grafts 3. flaps