Principles of wound closure Flashcards
Primary wound closure
-surgical incisions
Delayed primary closure
-resolve infection
-achieve debridement
-before granulation tissue
Secondary closure
-after granulation tissue
Advantages to primary closure
-optimal function
-best cosmetics
-shortest healing time
Wound selection for primary closure
-surgical incisions and lacerations if during golden period
-anatomic location
-regional blood supply
-tissue loss
What factors would make a wound not suitable for primary closure?
-tension
-motion
-devitalized tissue
-heavily contaminated (infection)
What suture would you avoid in closing non-surgical wounds?
Avoid braided suture
What are ways to manage tension?
-tension relieving sutures
-tissue undermining
-tension relieving incisions
-plasty procedures
-pre-suturing
What are tension relieving suture patterns?
-near far-far near
-vertical mattress (stented)
-horizontal mattress (stented)
What is point of stents?
Decrease pressure over higher SA
Issue with horizontal mattress
Risk of vascular compromise
-but helpful when there might be an issue with tissues ability to hold suture
Tissue undermining
Place scissors under the skin, open the jaws, and allow for SQ tissue to separate away allowing for tissue to be a bit more mobile
*issue= compromises blood supply and creates deadspace… so can put a drain
Tension relieving incisions
-full thickness skin stab incisions
-will help pull edges closer together and can be used as drain holes
Plasty procedures
-work with line of tension, to have it change from horizontal to vertical
-Make Z incisions and flip corners over
Pre-suturing
-large mattress sutures
-4-8hrs
-stress relaxes skin
-can also use tissue expanders
Considerations for wound repair decision
-Money
-Tissue loss
-extension of infection
Delayed primary closure timeline
Want to resolve infection and achieve debridement first
Then before granulation tissue (3-5days) can repair
What impacts the success of delayed primary closure?
-resolution of infection
-tension managed closure
Secondary closure advantages
-allows resolution of infection
-host debridement
Disadvantages of secondary closure
-tissue is less manipulative
-need tension relieving techniques (tissue undermining, relief incisions, tension relief sutures)
What are some alternatives to closure?
-second intention
-skin grafts
-flaps
