wound closure. aesthetic closure knowledge of healing mechanisms skin anatomy suture material and...

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Wound closure

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Wound closure

Aesthetic closure knowledge of healing mechanisms skin anatomy suture material and closure technique

Ensures optimal healing

Three distinct phases Inflammation

inflammatory cells into the wound inflammatory phase occurs in the first few days as

inflammatory cells migrate into the wound tissue formation

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 subcutane

ous tissues minimization of scar formation by careful epidermal align

ment avoidance of a depressed scar by precise eversion of ski

n edges secondary intention

spontaneous healing

Suture materials

natural and synthetic synthetic materials

less reaction less inflammatory reaction

absorbable and nonabsorbable nonabsorbable sutures offer longer mechanical su

pport 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 materia

l close tissue layers which require close approxim

ation 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 h

ernia or an appendiceal stump

Smead-Jones/Far-and-Near a double loop technique alternating far and

near stitches greater mechanical strength than continuo

us or simple interrupted sutures used for approximating fascial edges, es

pecially 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 depr

ession 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 !!!