primary wound closure Flashcards
what are some reasons to choose primary wound closure?
- decreased need for bandages
- faster resolution of wound
- less pain and scarring
- better cosmesis and protection of underlying structures
what are Halstead’s principles?
- gentle tissue handling
- control of hemorrhage
- observe strict aseptic technique
- preserve blood supply to the tissues
- eliminate dead space
- appose tissues accurately with minimal tension
do overweight dogs make a reconstruction of a wound more difficult?
yes
what happens when you add 2 extra throws to your knot?
increases the knot volume and tissue reactivity increases by a factor of 1.5
what type of closure would you use a cutting needle with?
subcuticular and intradermal
true or false.
it is acceptable to use 2-0 suture for cutaneous closure.
false, its too big, use 3-0 in dog and 4-0 in cats
can you use tissue adhesives like skin glue if there is tension in wounds?
no use sutures because they will hold stronger
when wounds are closed ____ the tension is reduced.
parallel
what is the exception where we can close wounds perpendicular to tension lines?
the extremities, closing parallel can sometimes create a torniquet effect
what is the simplest technique to relieve tension ?
undermine the tissue by blunt dissection technique or sharp dissection technique
what is important to remember about undermining tissue?
it also makes dead space
what are some tension relieving sutures?
- vertical mattress
- horizontal mattress
- far-far-near-near
- far-near-near-far
which tension relieving suture pattern is not ideal because it may compromise blood supply?
horizontal mattress
when do we use walking sutures?
when skin can’t be closed directly initially, this advances the skin towards the center of the wound
- ideal for large wounds with surrounding skin that is pliable
when is a V-Y plasty indicated ?
when there are chronic defects surrounded by inelastic skin and closing the wound would distort surrounding structures like the eye
where should the point of the chevron incision in a V-Y plasty be made?
away from the defect
why is a Z plasty used?
to create a wound adjacent to a high-tension wound to release tension and allow primary closure
what is mechanical creep?
skin extending its natural boundaries
what is the “rule of halves”?
to place first suture across the widest part of the wound then continue to divide each segment of defect in half with sutures
how do you close crescent shaped defects?
space the sutures farther apart along the longer side of the wound
how do you close a triangular shaped defect?
close the defect as a “Y” and suture towards center, use a half-buried horizontal mattress stitch to close the central portion of the “Y”
how do you close a circular defect ?
divide into 3 arcs and meet in the middle
why dont we close circular defects with direct apposition ?
will result in redundant tissue or “dog ears” at both ends of the suture line
if there is enough skin in a wound to create a new shape, what type of shape is ideal?
fusiform shape because its less likely to “dog ear”
