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RUSVM Small Animal Surgery 1 > Wound Closure > Flashcards

Wound Closure Flashcards

1
Q

What are the main benefits to primary wound closure?

A 
More straight forward wound care 
Decreased need for bandages
Faster resolution of the wound 
Less pain and scarring 
Better cosmetics and protection of underlying anatomic structures
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2
Q

What are the goals of wound closure?

A 
Minimal tension 
Full return to function (ROM, robust skin coverage) 
Pain free final outcome 
Cost effective 
Acceptable cosmetics 
Satisfied owner
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3
Q

What are Halsted’s principles?

A 
Gentile tissue handling 
Control of hemorrhage 
Aseptic technique 
Preserve blood supply to tissues 
Eliminate dead space 
Apposition tissue accurately with minimal tension
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4
Q

What size and type of suture should you used of fascial/intramuscular layers?

A

1-3.0 USP

monofilament absorbable > polydioxanone (most common)

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5
Q

What is the minimum number of throws to start and finish a continue suture pattern with PDS in fascial/intramuscular layers?

A

Start 5

Finish 7

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6
Q

What size and type of suture would you use in SQ layers?

A

3-0 or 4-0

Poligecaprone 25 (monocryl) 
Glycomer 631 (Biosyn) 
PDS
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7
Q

Adding 2 extra throws increases knot volume and tissue activity by a factor of _______

A

1.5

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8
Q

What are the typical closure patterns for subcuticular to intradermal layers?

A

Continuous horizontal

Continuous vertical

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9
Q

What size and type of suture do you use in cutaneous layers?

A

3-0 or 4-0

Ethilon (nylon)
Polypropylene (prolene)

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10
Q

When would a tissue adhesive, like cyanoacrylate, would not be appropriate to close a cutaneous wound?

A

Wounds with tension (only 15% as strong as wounds closed with suture)

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11
Q

Too much tension when closing a wound can cause??

A

Ischemia from pressure exerted by sutures

“Biologic tourniquet”

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12
Q

Tension lines serve as a guideline for wound closure because tension is reduced when wounds are closed __________ to these lines

A

Parallel

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13
Q

How can you assess tension around a wound?

A

Place animal in natural standing position

Gently lift/tent skin surrounding wound

Manipulate in several directions

Desired direction is that which result s in the least amount of tension

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14
Q

What are methods of relieving tension?

A

Undermining tissue

Tension reliving suture patterns

Releasing incisions

Walking sutures

V-Y / Z / M plasty

Stretching techniques

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15
Q

What technique do you use to undermine tissue?

A

Metzenbaum scissors to undermine skin and SQ

  • blunt (closed to open blade) -> loose areolar hypodermal tissues
  • sharp (open to closed blade) -> snipping tissue with scissor
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16
Q

When undermining tissue, it is critical that the peri-wound is healthy and pliable with respect to blood supply, inflammation, and edema. How is this blood supply maintained?

A

The direct cutaneous vessel is elevated with the undermined skin

-> preserves blood supply to the deep subdermal plexus, which will arborize to perfuse the dermis through superficial plexi

17
Q

What are the tension-relieving suture patterns?

A

Mattress sutures (or through rubber stents)

Far-far-near-near
Far-near-far-near

18
Q

What is the main concern when using a horizontal mattress suture to relieve tension?

A

Horizontal component may compromise blood supply

19
Q

How do releasing incisions relieve tension?

A

Make relaxing incisions near the defect to allow skin apposition

After undermining the skin -> unilateral or bilateral simple relaxing incisions made adjacent to the wound

After prefacing a continuous subcuticular suture pattern —> multiple punctate incisions are made parallel to wound

20
Q

How is a walking suture placed?

A

Place suture through the fascia of the body wall at a distance closer to the center of the wound than the bite through the subdermal fascia or deep dermis

21
Q

When is walking suture ideal?

A

Large open wounds with surrounding skin that is pliable

22
Q

What method provides tension relief adjacent to an orifice or can be used in chronic defects surrounded by inelastic skin and closing wounds near structures that would be distorted by closure under tension?

A

V-Y plasty

23
Q

What method can you use to close a wound when there is insufficient laxity parallel to the wound to permit skin stretch ?

A

Z-plasty

24
Q

The central arm of the Z plasty is __________ to the long axis of the wound?

A

Perpendicular

25
Q

What method is used in fusiform wounds where the skin at one/both ends is limited?

A

M-plasty

26
Q

What is mechanical creep?

A

Tension applied to skin gradually over 2-4days

—> randomly oriented dermal collagen and elastic fibers straighten and elongate, becoming more parallel to tension lines which allows for lengthening of the skin

27
Q

What is stress relaxation?

A

Over time, less force is required to maintain collagen fibers in their stretched position because the skin’s elastic fibers lose their natural recoil

28
Q

What are methods of stretching skin to close wounds under tension?

A

Pre-suturing
Skin stretchers
Inflatable tissue expanders
Adjustable sutures

29
Q

How should you close fusiform shaped defects?

A

1st suture across widest part

Continue to divide each segment in half with subsequent sutures

30
Q

How should you close crescent shaped defects?

A

Begin at midpoint and divide each segment in half
Space sutures farther apart on the longer side of the wound

OR

Close end to end and remove redundant skin —> close in T

31
Q

How can you close a triangular shaped defect?

A

Close defect as a “Y” by beginning at each point and suturing toward the center

Use a half-buried horizontal mattress stitch to close the central portion of the “Y”

32
Q

How can you close a circular shaped defect?

A

Close by direct apposition —> results in excessive redundant tissue at both ends (dog ears)

Divide circle into 3 arcs and meet in the middle
-> will likely still result in dog ear on at least one arc

If adequate skin -> convert to fusiform shape

33
Q

How can square/ rectangular wounds be closed?

A

Rectangle —> double “Y”

Square —> double “X”

34
Q

How can “step defects” be corrected?

A

Manipulation of knot —> pull to low side

Placement of suture at same depth on both sides of wound

Half-buried horizontal mattress (intradermal portion on low side)

Stiff untied suture from superficial on high side to deep on low side

35
Q

How can you correct a dog ear?

A

Small —> suture manipulation of skin
-apex cutaneous suture pulls ear down and away from wound

Large —> resect and close

36
Q

What postop analgesia do you use for wounds?

A

NOCITA (bupivacaine liposome injectable suspension)

Labeled for single-dose infiltration into the surgical site to provide oral postop analgesia for cranial cruciate ligament surgery in dogs

RUSVM Small Animal Surgery 1 (39 decks)

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