Wound closure
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Transcript Wound closure
Wound closure
Aesthetic closure
knowledge of healing mechanisms
skin anatomy
suture material and closure technique
Ensures optimal healing
Three distinct phases
Inflammation
tissue formation
inflammatory cells into the wound
inflammatory phase occurs in the first few days as
inflammatory cells migrate into the wound
epithelial cells has been shown to occur within the first
12-24 hours
further new tissue formation occurs over the next 10-14
days
tissue remodeling
wound contraction and tensile strength is achieved
occurs in the next 6-12 months
Affect wound healing
systemic illness
local factors
Two types of wound healing
primary intention
surgical wound closure facilitates the biological event of
healing by joining the wound edges
minimize new tissue formation
elimination of dead space by approximating the
subcutaneous tissues
minimization of scar formation by careful epidermal
alignment
avoidance of a depressed scar by precise eversion of
skin edges
secondary intention
spontaneous healing
Suture materials
natural and synthetic
synthetic materials
absorbable and nonabsorbable
less reaction
less inflammatory reaction
nonabsorbable sutures offer longer mechanical
support
monofilament and multifilament
monofilaments have less drag
Infection is avoided
Absorbable suture materials
lose tensile strength before complete absorption
gut last 4-5 days in terms of tensile strength
chromic form, gut can last up to 3 weeks
Vicryl and Dexon
maintain tensile strength for 7-14 days
complete absorption takes several months
Maxon and PDS
long-term absorbable sutures
lasting several weeks
requiring several months for complete absorption
Nonabsorbable sutures
silk has the lowest strength
nylon has the highest
Suture technique
Running, or continuous stitch
made with one continuous length of suture
material
close tissue layers which require close
approximation
speed of execution, and accommodation of edema
during the wound healing process
greater potential for malapproximation of wound
edges with the running stitch than with the
interrupted stitch
needle at a 90° angle to the skin within 1-2
mm of the wound edge and in the superficial
layer
exit through the opposite side equidistant to
the wound edge and directly opposite the
initial insertion
Interrupted stitch
stitch is tied separately
used in skin or underlying tissue layers
more exact approximation of wound
edges can be achieved with this technique
than with the running stitch
Mattress suture
a double stitch that is made parallel
(horizontal mattress) or perpendicular
(vertical mattress) to the wound edge
advantage of this technique is
strength of closure
each stitch penetrates each side of the wound
twice
inserted deep into the tissue
Purse string
continuous stitch paralleling the edges of a
circular wound
wound edges are inverted when tied
used to close circular wounds, such as
hernia or an appendiceal stump
Smead-Jones/Far-and-Near
a double loop technique alternating far and
near stitches
greater mechanical strength than
continuous or simple interrupted sutures
used for approximating fascial edges,
especially for patients at risk for fascial
disruption or infection
Continuous Locking, or Blanket Stitch
a self-locking running stitch used primarily
for approximating skin edges
good approximation edges is paramount to proper
wound closure technique
deep sutures serve to eliminate the dead space and
relieve tension from the wound surface
deep sutures also ensure proper alignment of the
wound edges and contribute to their final eversion
wound closure may require sharp undermining of
the tissues to minimize tension on the wound
achieve hemostasis
eversion of all skin edges avoids unnecessary
depression of the resultant scar
Immediate and delayed complications may
occur with wound closure
immediate complications
formation of hematoma
wound infectionp
prophylactic antibiotics
late complications
scar formation
excess tension
lack of eversion of the edges
hypertrophic scarring and keloid formation\
stitch marks
wound necrosis
Suture removal
face: 3-4 days
scalp: 5 days
trunk: 7 days
arm or leg: 7-10 days
foot: 10-14 days
Thanks for your attention !!!