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Surgical skills > Primary wound closure > Flashcards

Primary wound closure Flashcards

1
Q

What is delayed primary closure?

A

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

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2
Q

What is secondary closure?

A

closure after granulation tissue

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3
Q

What is secondary closure?

A

closure after granulation tissue

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4
Q

what is primary wound closure?

A

closure of a surgical incision (or fresh wound?)

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5
Q

What are the advantages of primary wound closure?

A
  1. optimal function
  2. best cosmetics
  3. shortest healing time
  4. usually earliest return to function
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6
Q

When is primary wound closure used?

A
  1. surgical incisions

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

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7
Q

How can anatomic location affect the closure choice?

A
  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
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8
Q

What are issues with wounds on the limbs?

A
  1. high movement
  2. poor vascular supply
  3. tissue loss
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9
Q

What are three reasons why wounds should not be closed?

A
  1. tension
  2. motion
  3. tissue considerations
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10
Q

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

A

tension

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11
Q

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

A

motion

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12
Q

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

A

(besides pulling apart)

they can pull air into the wound

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13
Q

What are three things to do with primary wound closure?

A
  1. anatomic reconstruction
  2. tension free coaptation
  3. in nonsurgical wounds avoid braided suture
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14
Q

What are three things to do with primary wound closure?

A
  1. anatomic reconstruction
  2. tension free coaptation
  3. in nonsurgical wounds avoid braided suture
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15
Q

What are three reasons for failure of primary wound closure?

A
  1. tension
  2. devitalized tissue
  3. infection
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16
Q

What are 5 ways to manage tension?

A
  1. tension relieving sutures
  2. tissue undermining
  3. tension relieving sutures
  4. plasty procedures
  5. pre-suturing
17
Q

What are tension relieving sutures?

A
  1. near-far-far-near
  2. vertical mattress
  3. stented vertical mattress
  4. horizontal mattress
  5. stented horizontal mattress
18
Q

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

A

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

19
Q

How is vettical mattress used as a tension relieving pattern?

A

by interspersing it with simple interrupted pattern

20
Q

Why may you use a stented vertical mattress?

A

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

21
Q

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

A

it causes vascular compromize

22
Q

What does tissue undermining do?

A

it makes hte skin more mobile

23
Q

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

A

stick to the subQ space

24
Q

What are tension relieving incisions?

A

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

25
Q

What are plasty procedures?

A

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

26
Q

What are the features of presuturing?

A
  1. use large mattress sutures, typically vertical mattress. pull the skin across. Leave for 4-8 hours and the stress relaxes the skin
27
Q

When is pre-suturing most often used?

A

When want to remove a mass

28
Q

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

A
  1. client money
  2. tissue loss
  3. extension of infection
29
Q

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

A
  1. client money
  2. tissue loss
  3. extension of infection
30
Q

When is closure performed for delayed primary closure?

A

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

31
Q

The success of delayed primary closure depends on what?

A
  1. resolution of infection

2. tension managed closure

32
Q

What are the advantaes of secondary closure?

A
  1. allows resolution of the infection

2. host debridement of tissue

33
Q

What is the disadvantage of secondary closure?

A
  1. tissue is less manibulative (more fibrous skin margins, difficult to get tension relief)
34
Q

What are tissue relieving techniques used in secondary closure?

A
  1. tissue undermining
  2. relief incisions
  3. tension relieving sutures
35
Q

What are alternatives to clsoure?

A
  1. second intention (open wound)
  2. skin grafts
  3. flaps
36
Q

What are alternatives to closure?

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

Surgical skills (23 decks)

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