Wound closure
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Aesthetic closure
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knowledge of healing mechanisms
skin anatomy
suture material and closure technique
Ensures optimal healing
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Three distinct phases
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Inflammation
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tissue formation
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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
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wound contraction and tensile strength is achieved
occurs in the next 6-12 months
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Affect wound healing
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systemic illness
local factors
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Two types of wound healing
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primary intention
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surgical wound closure facilitates the biological event of
healing by joining the wound edges
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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
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spontaneous healing
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Suture materials
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natural and synthetic
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synthetic materials
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absorbable and nonabsorbable
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less reaction
less inflammatory reaction
nonabsorbable sutures offer longer mechanical
support
monofilament and multifilament
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monofilaments have less drag
Infection is avoided
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Absorbable suture materials
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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
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maintain tensile strength for 7-14 days
complete absorption takes several months
Maxon and PDS
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long-term absorbable sutures
lasting several weeks
requiring several months for complete absorption
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Nonabsorbable sutures
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silk has the lowest strength
nylon has the highest
Suture technique
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Running, or continuous stitch
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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
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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
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Interrupted stitch
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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
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Mattress suture
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a double stitch that is made parallel
(horizontal mattress) or perpendicular
(vertical mattress) to the wound edge
advantage of this technique is
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strength of closure
each stitch penetrates each side of the wound
twice
inserted deep into the tissue
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Purse string
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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
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Smead-Jones/Far-and-Near
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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
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Continuous Locking, or Blanket Stitch
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a self-locking running stitch used primarily
for approximating skin edges
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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
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Immediate and delayed complications may
occur with wound closure
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immediate complications
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formation of hematoma
wound infectionp
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prophylactic antibiotics
late complications
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scar formation
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excess tension
lack of eversion of the edges
hypertrophic scarring and keloid formation\
stitch marks
wound necrosis
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Suture removal
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face: 3-4 days
scalp: 5 days
trunk: 7 days
arm or leg: 7-10 days
foot: 10-14 days
Thanks for your attention !!!