The engineering of sutures in synthetic material along with standardization of traditional materials (eg, catgut, silk) has made for superior aesthetic results. In doing so, absorbable sutures help decrease the tension and better approximate the wound edges. The strongest is closure of the deep dermis with a figure-of-eight suture using a resorbable suture (ie, polyglycolic acid) followed by closure of the dermis with intradermal suture ( Fig 10.1-8 ). Staples, although popular and frequently used, are not considered first choice, if cosmetically nice-looking scars are expected. Simple interrupted suturing is still a preferred technique when you want the most meticulous repair, but when dealing with less cosmetic areas, I like this technique as it is involves less knot tying and gets the job done… Suture techniques. They are cause minimal wound inflammation, have a lower infection rate than sutures, and are removed easily. If there is still tension after wound closure, the mattress stitch can be left in place to decrease the risk of dehiscence. Wound healing occurs in three phases: inflammatory, proliferative, and remodeling and maturation (chapter 4). Techniques of wound closure Although many wounds in horses heal successfully by second-intention healing or delayed closure, some wounds can be sutured primarily, with reasonably high expectations of first-intention healing. They can be thrown in as temporary stitches are removed after the tension is more evenly distributed across the wound. These sutures have been adequately described in numerous textbooks or specialized manuals and do not need repeating here. Click here to Login. 2007 May;58(5):566-72. doi: 10.1097/01.sap.0000245135.58229.e7. Pearls for Adjunctive Closures Staples • With the stapler centered over the wound, press it gently but firmly against the wound and depressed the trigger • This is a common mistake. Keep in mind that edema is common after injury or surgery, so the degree of tension on the skin will often increase during the first few days after closure. 2020 Apr 9;4(4):CD012124. I suggest review and mastery of the basic wound closure techniques before attempting these techniques in patient care. Subcuticular sutures for skin closure in non-obstetric surgery. However, monofilament sutures do not hold a knot as well as braided suture. The accepted surgical practice is to use the smallest diameter suture that will adequately hold the mending wounded tissue. 2019 Mar;144(3):283-289. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Caring for and closing wounds in certain areas involve additional risks and require special techniques. In: StatPearls [Internet]. The least amount of observable scar is created with a running, nonresorbable, intradermal suture with the least inflammatory response (ie, polypropylene) ( Fig. USA.gov. Sutures that undergo degradation and resorption in tissues are considered resorbable sutures. While in general, surgical incisions should always be closed primarily, this does not apply to all wounds not associated with a fracture, although many of them may also be closed primarily ( Fig 10.1-1a–c ). Dissection at the proper depth is facilitated by the use of a single-prong … Fine approximation of the corner or apex can be performed with single knots using thin suture material or Steri-Strip™. In the past, surgeons have been taught to leave wounds associated with internally fixed fractures open at the time of the first debridement and irrigation. Cochrane Database Syst Rev. Because of concerns about runoff of adhesive from wounds, a new, higher viscosity formulation has been introduced. 2019 Mar 28;28(6):S24-S28. 2019;7:7. As a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Many techniques are used for the closure of the wounds because only one technique is not enough for all situations. Regardless of which wound closure technique the responder chooses, it is important to remember that to achieve a thoroughly-healed incision with minimum scarring you should keep in mind the following: Line up the skin edges precisely to ensure minimal scarring. This site needs JavaScript to work properly. Simple, interrupted suture technique. 1- Primary Suture Line These sutures can be mentioned … A good measure to judge the tension of skin edges is impaired vascular perfusion or lack of capillary refill when tying the sutures, as may best be seen when the skin appears blanched between stitches. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. HHS Nursing, Allied Health, and Interprofessional Team Monitoring. They provide greater tensile strength and have less risk of injuring cutaneous circulation. Dermabond comes in a sterile, plastic-covered glass vial with an applicator tip ( Fig. Tension on the suture from below is avoided by separately closing the subcutaneous tissue first at fascia level (as shown here), or at a dermal level. Synthetic sutures tend to have a problem with “memory.” That is, they tend to retain the shape of their packaging. Systemic factors and associated conditions must also be taken into consideration when deciding whether to close a wound primarily or not (chapter 4.4). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Variations on the ellipse can be utilized on particular surfaces such as those that are convex, curvilinear, or limited by anatomic boundaries. | Monofilament sutures are made of a single strand of material. Suture size is stated numerically; as the number preceding the zero in the suture size increases, the diameter of the strand decreases, eg, 4-0 is much smaller than 1-0 or even 1. 2019 Feb 01;85(2):162-166. A good resultant scar begins with a properly designed incision, gentle and atraumatic handling of tissues, selection of the appropriate closure material, and correct reapproximation of the edges. Br J Nurs. This is an important consideration in: In each of these situations there frequently is an extensive zone of injury beyond the central area of nonviable tissue, and a zone of questionable tissue viability in between (chapter 3, 10.3.3). Joint capsules and fascia are usually closed using a simple interrupted suture ( Fig 10.1-2 ), figure-of-eight suture ( Fig 10.1-3 ) or a running suture ( Fig 10.1-4 ). Assessment of Wound Closure Techniques in Primary Spine Surgery Using SPY Intra-operative Angiography: Actual Study Start Date : April 1, 2019: Estimated Primary Completion Date : December 31, 2021: Estimated Study Completion Date : December 31, 2021: Resource links provided by the National Library of Medicine. Furthermore, there is no set rule that postulates: this layer needs this specific suture technique and this specific suture material. The choice of suture and technique depends on the type of wound, depth, the degree of tension, and desired cosmetic results. According to the characteristics of the wound, the medical team can choose to encourage its closure or not. Care should be taken when applying these sutures as to the depth of the wound because they can form a potential cavity beneath the suture line if the wound is deep. In percutaneous wounds or simple pediatric cases, skin glues are particularly useful as they are quick and relatively painless. Nonresorbable sutures are typically used for skin and tendon repair. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. -. As a general rule, resorbable sutures are used for closure of fascial layers, subcutaneous tissue (ie, the approximation of the superficial fascia of the fat), and joint capsules. Heavily contaminated wounds (stagnant water, farmyard, etc), Large soft-tissue defects (high-energy weapons, shotgun), Animal or human bites (except facial bites). When primary closure is not immediately possible, delayed primary closure may be considered. 2008 Apr-Jun;43(2):222-4. doi: 10.4085/1062-6050-43.2.222. By Joint Arthroplasty Mountain Meeting (JAMM) FEATURING Fred Cushner. Most surgeons believe that wound debridement and irrigation should occur within 6–8 hours, although some would consider 12 hours to be acceptable. Small, clean, simple lacerations with minimal retraction may be managed with noninvasive techniques, including suture strips (ie, Steri-Strip™, 3M™, St. Paul MN, USA), mesh and/or cutaneous adhesives, (ie, Prineo®, Dermabond®, Johnson & Johnson Medical Ltd., New Brunswick, NY, USA). The clinicians care for wounds ranging from minor and simple lacerations or abrasions to complex wounds. This practice minimizes trauma while the suture is passed through the tissue to effect closure. To expect to achieve these results, one needs to have a rational treatment plan. Featured Video. 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