WOUND CLOSURE

Question 1

Three types of wound closure

Answer 1

Primary
Secondary
Delayed (Tertiary)

Question 2

Indications for secondary closure

Answer 2

Highly contaminated wounds
Infected wounds
High risk of infection

Question 3

Best needle

Answer 3

Reverse cutting needing

Question 4

3 things we don’t use cutting needles for

Answer 4

Tendon
Muscle
Liver

Question 5

Ethilon Suture: Class, structure, raw material, tissue reactivity, ED indications

Answer 5

Class: nonabsorbable suture
Structure: Monofilament, braided
Raw material: Polymide polymer
Tissue Reactivity: Minimal
ED indications: soft tissue and skin reapproximation

Question 6

Prolene Suture: Class, structure, raw material, tissue reactivity, ED indications

Answer 6

Class: nonabsorbable suture
Structure: Monofilament
Raw material: Polypropylene polymer
Tissue Reactivity: Least
ED indications: soft tissue and skin reapproximation, tendon repair

Question 7

Monocryl Suture: Class, structure, raw material, tissue reactivity, Tensile Strength retention at 14 d, Absorption rate, ED indications

Answer 7

Class: absorbable suture
Structure: Monofilament
Raw material: Copolymer of glycolide and epsilon-caprolactone
Tissue Reactivity: Minimal
Tensile Strength retention at 14 d: 40 %
Absorption rate: 3 months
ED indications: Subcutaneous soft tissue approximation

Question 8

Vicryl Suture: Class, structure, raw material, tissue reactivity, Tensile Strentgh retention at 14 d, Absorption rate, ED indications

Answer 8

Class: Absorbable suture
Structure: Braided
Raw material: Copolymer of lactide and glycolide coated with polyglactin 370 and calcium sterate
Tissue Reactivity: Minimal
Tensile Strentgh retention at 14 d: 75 %
Absorption rate: 56 - 70 d
ED indications: Subcutaneous soft tissue approximation, ligation vessels, muscle suture

Question 9

PDS Suture: Class, structure, raw material, tissue reactivity, Tensile Strentgh retention at 14 d, Absorption rate, ED indications

Answer 9

Class: absorbable suture
Structure: Monofilament
Raw material: Polyester polymer
Tissue Reactivity: Minimal
Tensile Strentgh retention at 14 d: 70%
Absorption rate: 180 - 210 d
ED indications: Subcutaneous soft tissue approximation when prolonged strength is needed, tendon repair

Question 10

Recommended suture size: Scalp, Face, Trunk, Extremities, Digits

Answer 10

Scalp: 3-0 OR 4-0
Face: 6-0
Trunk: 4-0
Extremities: 4-0
Digits: 5-0

Question 11

Duration of suture: face, scalp, joint, trunk, extremities, digits

Answer 11

5 on the face
10-14 over a joint and on the scalp
7 for everything else

Question 12

Simple Interrupted Percuaneous Sutures: indications and steps

Answer 12

Indications: Low-tension wounds

Steps:
Insert needle at 90 degrees to the skin
Drive needle through the dermis until the tip exits the skin
Grasp needle behind the tip and pull it though the wound
Suture should enter and exit the skin equidistant from the wound edge
Suture depth should be greater than suture width to promote eversion
Pull the suture to oppose the wound edges
Complete the knot to one side of the laceration
Sutures are tied square knot, then number of ties correspond to the suture gauge

Question 13

How to acheive wound eversion

Answer 13

Suture depth should be greater than suture width

Question 14

Continuous Percuaneous Sutures: Indications

Answer 14

Indications: Percutaneous closure in conjunction with deep sutures
Long Linear sutures

Question 15

Deep dermal Sutures: Indications

Answer 15

High tension wounds
Closure of dead space

Question 16

Cutinuous Subcuticular Suture: Indications

Answer 16

Cosmetically visible areas to reduce scarring
In conjunction with deep dermal sutures

Question 17

Horizontal Mattress Sutures: Indications

Answer 17

Volar surface of hands
Initial approximation of high-tension wounds