primary wound closure

Question 1

what are some reasons to choose primary wound closure?

Answer 1

• decreased need for bandages
• faster resolution of wound
• less pain and scarring
• better cosmesis and protection of underlying structures

Question 2

what are Halstead’s principles?

Answer 2

• 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

Question 3

do overweight dogs make a reconstruction of a wound more difficult?

Answer 3

yes

Question 4

what happens when you add 2 extra throws to your knot?

Answer 4

increases the knot volume and tissue reactivity increases by a factor of 1.5

Question 5

what type of closure would you use a cutting needle with?

Answer 5

subcuticular and intradermal

Question 6

true or false.

it is acceptable to use 2-0 suture for cutaneous closure.

Answer 6

false, its too big, use 3-0 in dog and 4-0 in cats

Question 7

can you use tissue adhesives like skin glue if there is tension in wounds?

Answer 7

no use sutures because they will hold stronger

Question 8

when wounds are closed ____ the tension is reduced.

Answer 8

parallel

Question 9

what is the exception where we can close wounds perpendicular to tension lines?

Answer 9

the extremities, closing parallel can sometimes create a torniquet effect

Question 10

what is the simplest technique to relieve tension ?

Answer 10

undermine the tissue by blunt dissection technique or sharp dissection technique

Question 11

what is important to remember about undermining tissue?

Answer 11

it also makes dead space

Question 12

what are some tension relieving sutures?

Answer 12

• vertical mattress
• horizontal mattress
• far-far-near-near
• far-near-near-far

Question 13

which tension relieving suture pattern is not ideal because it may compromise blood supply?

Answer 13

horizontal mattress

Question 14

when do we use walking sutures?

Answer 14

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

Question 15

when is a V-Y plasty indicated ?

Answer 15

when there are chronic defects surrounded by inelastic skin and closing the wound would distort surrounding structures like the eye

Question 16

where should the point of the chevron incision in a V-Y plasty be made?

Answer 16

away from the defect

Question 17

why is a Z plasty used?

Answer 17

to create a wound adjacent to a high-tension wound to release tension and allow primary closure

Question 18

what is mechanical creep?

Answer 18

skin extending its natural boundaries

Question 19

what is the “rule of halves”?

Answer 19

to place first suture across the widest part of the wound then continue to divide each segment of defect in half with sutures

Question 20

how do you close crescent shaped defects?

Answer 20

space the sutures farther apart along the longer side of the wound

Question 21

how do you close a triangular shaped defect?

Answer 21

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”

Question 22

how do you close a circular defect ?

Answer 22

divide into 3 arcs and meet in the middle

Question 23

why dont we close circular defects with direct apposition ?

Answer 23

will result in redundant tissue or “dog ears” at both ends of the suture line

Question 24

if there is enough skin in a wound to create a new shape, what type of shape is ideal?

Answer 24

fusiform shape because its less likely to “dog ear”