WOUND CLASSES, INCISIONS AND CLOSURE
Class I –
Class II –
Class III –
Class IV –
Incision Qualities – Things that affect
healing and infection potential!
1.
2.
3.
4.
Wound Evaluation – Things to consider
before closure!
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
1.
Contraindication for Closure
Closure – How and When
Intentions – Healing
2.
3.
Methods of Wound Closure
Sutures
Staples
Disposable/nondisposable
Generally preloaded sterile cartridges
Single/double row based on type
Model name/# = stapler type and size
Stainless steel, titanium, nonmetallic
Color coded to match with stapler
Previously discussed
Staples -More Rapid method of general
tissue closure – skin, organ, vessel
Ligature Clips
Absorbable/nonabsorbable
Generally preloaded sterile cartridges
Clip applier with single or multi clips
Color coded to match applier
ALTERNATIVES
Tapes
Clips – used to occlude tubular structures,
most often vessels, or can be used to mark
anatomical areas for later x-rays
Appliers – Provide the mechanism to
clamp the clips around the vessel
ALTERNATIVES
Skin closure strips or tapes – Used to
approximate skin edges where flexibility
and adherence are key
Umbilical tape – White, woven cotton
ligature used to isolate and suspend small
vessels/structures – pedi and vascular
Topical adhesives – Biologic or synthetic
derivatives that glue surface tissues
together to eliminate the need for postop
suture removal
Surgical glue – Used within incision to
adhere deeper tissues and organs
Silicon tubelike strand used for retracting
and occluding blood vessels in MIS
Performs tissue repair as it reinforces or
bridges wound areas that are under tension
or too weak.
Strips with adhesive backing or not
Adhesives
Glues or gels, some requiring preparation,
such as heating, stirring or breaking
capsule
Vessel loops
Surgical mesh
Absorbable or nonabsorbable
Stainless steel
Mesh - poly-fiber/propylene/glactin
Biologic or synthetic mesh
Bone wax
Tissue replacement
Wound Zippers
Staplers – Provide the action (firing) that
drive and secures the skin and vascular
staples in tissue
Sterile preparation rubbed into bleeding
points on surface of bone for hemostasis
Biologic or synthetic tissue grafts, implants
or transplants
Used for repeated opening and closing of a
particular incision
Uses, benefits, disadvantages of surgical staples and ligating clips instrumentation
USES
Specialty Surgical Staplers
Vessel sealing/ligating system
Benefits
Disadvantages
Loading, Handling and Cleaning Devices
1. Biopsy and resection
2. Anastomosis
3. Ligation
4. Division of Tissue
5. Organ, Fascia and Skin Closure
1. Skin, Fascia
2. Ligating and Dividing
3. Intestinal, Pulmonary
4. Endoscopic
Permanently fuses tissues/vessels
1. Speed – Decreases op/anesthesia time
2. Efficiency – Minimizes tissue handling
3. Positive, minimal impact –
Reduces blood loss, postop complications
Acceleration of wound healing
1. Difficult with cost containment
2. Must be precisely placed
3. Potential for errors in technique
 Load cartridges per stapler/clip
specific or mfg instructions
 Prepare for surgeon
 Disassemble and clean nondisposable units post surgery
 Sterilize multi-use units
 Dispose of single use in sharps box
WOUND TERMINOLOGY
ADHESION
CICATRIX
KELOID
DEHISCENCE
EVISCERATION
GRANULATION
DEAD SPACE
DEVITALIZED