Primary wound closure Flashcards
What is delayed primary closure?
where you resolve the infection and achieve debridement and closure before granulation tissue
What is secondary closure?
closure after granulation tissue
What is secondary closure?
closure after granulation tissue
what is primary wound closure?
closure of a surgical incision (or fresh wound?)
What are the advantages of primary wound closure?
- optimal function
- best cosmetics
- shortest healing time
- usually earliest return to function
When is primary wound closure used?
- surgical incisions
2. lacerations–e.g. acute open tendon sheaths,
How can anatomic location affect the closure choice?
- the head has little motion and good blood supply
- the body also reponds fairly well
- the limbs may not have enough tissue to close an more motion. can also get more tissue loss
What are issues with wounds on the limbs?
- high movement
- poor vascular supply
- tissue loss
What are three reasons why wounds should not be closed?
- tension
- motion
- tissue considerations
What is the #1 reason not to do primary wound closure?
tension
What is the #2 reason not to do primary wound closure?
motion
If there is a lot of movement with wounds, what can happen?
(besides pulling apart)
they can pull air into the wound
What are three things to do with primary wound closure?
- anatomic reconstruction
- tension free coaptation
- in nonsurgical wounds avoid braided suture
What are three things to do with primary wound closure?
- anatomic reconstruction
- tension free coaptation
- in nonsurgical wounds avoid braided suture
What are three reasons for failure of primary wound closure?
- tension
- devitalized tissue
- infection
What are 5 ways to manage tension?
- tension relieving sutures
- tissue undermining
- tension relieving sutures
- plasty procedures
- pre-suturing
What are tension relieving sutures?
- near-far-far-near
- vertical mattress
- stented vertical mattress
- horizontal mattress
- stented horizontal mattress
Why is a near-far-far-near a useful tension relieving suture?
because it is an appositional pattern, and the suture material only has to be half as strong (pulley system)
How is vettical mattress used as a tension relieving pattern?
by interspersing it with simple interrupted pattern
Why may you use a stented vertical mattress?
if there is a lot of tension-used to resist cutting into the tissue. can sue IV tubing
What is a problem with using the horizontal mattress as a tension relieving suture?
it causes vascular compromize
What does tissue undermining do?
it makes hte skin more mobile
How do avoid compromizing the vascular supply to the skin while undermining it?
stick to the subQ space
What are tension relieving incisions?
They are stagger stab incisions which open up when the large wound is closed?
What are plasty procedures?
cuts made in the skin to move flaps to different locations to close a wound
What are the features of presuturing?
- use large mattress sutures, typically vertical mattress. pull the skin across. Leave for 4-8 hours and the stress relaxes the skin
When is pre-suturing most often used?
When want to remove a mass
What can be some negative consequences of failure of a primary wound closure?
- client money
- tissue loss
- extension of infection
What can be some negative consequences of failure of a primary wound closure?
- client money
- tissue loss
- extension of infection
When is closure performed for delayed primary closure?
After resolution of infection and debridement and before granulation tissue days3-5
The success of delayed primary closure depends on what?
- resolution of infection
2. tension managed closure
What are the advantaes of secondary closure?
- allows resolution of the infection
2. host debridement of tissue
What is the disadvantage of secondary closure?
- tissue is less manibulative (more fibrous skin margins, difficult to get tension relief)
What are tissue relieving techniques used in secondary closure?
- tissue undermining
- relief incisions
- tension relieving sutures
What are alternatives to clsoure?
- second intention (open wound)
- skin grafts
- flaps
What are alternatives to closure?
- second intention (open wound)
- skin grafts
- flaps
