In a case where you have a linear laceration located on the scalp or extremities, it is a reasonable alternative to use staples. The choice of suture and technique depends on the type of wound, depth, the degree of tension, and desired cosmetic results. Techniques for acute wound closure Tanya Reynolds Nurse consultant, Accident and emergency care, accident and emergency department, Homerton Hospital Elaine Cole Lecturer/practitioner, Accident and emergency/trauma, St Bartholomew School of Nursing and Midwifery, City University/Barts and The London NHS Trust, London -, Heinemann N, Solnica A, Abdelkader R, Gutman J, Nalbandian N, Raizman E, Hochner-Celnikier D. Timing of staples and dressing removal after cesarean delivery (the SCARR study). 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. The goal of all these different techniques of suturing the skin is to provide a mechanical closure of the wound without putting too much tension on the wound edges, allowing for uneventful reepithelialization within 24 hours. Use skin adhesives and/or glue in conjunction or an adjunct to sutures or staples to strengthen the closure of your wound. Br J Nurs. 2019 Feb 01;85(2):162-166. The more heavily contaminated the wound, the more important a shorter time to debridement (chapter 7.1) becomes. Do not pull too hard in trying to reduce tension with sutures as that can lead to further wound breakdown. MedlinePlus related topics: Spine Injuries and Disorders Wounds and Injuries. de Azevedo JM, Gaspar C, Andresen C, Barroso M, Costa H. Negative pressure wound therapy for skin graft closure in complex pilonidal disease. Login to view comments. The decision in favor of closing the skin or of open wound management depends on the likely success of primary closure, which in turn heavily depends on the surgeon′s experience. 2020 Apr 9;4(4):CD012124. 3 Superficial fascia of the fat (hypodermis/subcutaneous tissue). V-Y advancement is a modification of the advancement flap. Joint capsules and fascia are usually closed using a simple interrupted suture , figure-of-eight suture or a running suture . The wound may be conditioned for closure with a synthetic-skin substitute (eg, Epigard®, Pfizer, New York, NY, USA), which is applied to the wound initially, then removed after swelling abates and primary closure is made. Table 10.1-2 shows representative suture types and their characteristics. 10.1-8 ). Many surgeons today believe that wounds of open fractures—up to Gustilo type IIIA fracture—may be closed primarily, which is, however, still controversial [1, 2]. These include sutures, staples, and adhesives. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Softtissue edema and contamination of the wound are two major reasons not to use running sutures for skin closure, but rather interrupted sutures. Too much tension on the wound edges is the greatest enemy of primary wound closure. In percutaneous wounds or simple pediatric cases, skin glues are particularly useful as they are quick and relatively painless. This will allow for a lower risk of wound dehiscence and a more aesthetically pleasing outcome. 2018 Nov;6(11):e2001. Note that the far limb of the suture (1) remains within the dermal layer. This site needs JavaScript to work properly. Polyglactin (eg, Vicryl®, Vicryl rapide®, Vicryl plus®), 75% at 14 days 50% at 21 days 25% at 28 days, Polyglactin 370 IRGACARE MP** (triclosan). Wound Closure Techniques: Can Better Wound Healing Be Achieved? -, Fayyaz GQ, Gill NA, Alam I, Chaudary A, Aslam M, Ishaaq I, Hameed A, Ganatra A, Sheikh T, Bilal M. Continuous Versus Interrupted Sutures for Primary Cleft Palate Repair. Instead of using Donati-type mattress suture, Allgöwer described a modification called the Allgöwer-Donati suture ( Fig 10.1-9 ), where the opposite skin edge is caught and exited within the dermis. Both fascia and joint capsules should be closed to form a water-tight layer in order to prevent bacteria from gaining access … The skin is not pierced and thus has the ability to produce better aesthetic results. 2008 Apr-Jun;43(2):222-4. doi: 10.4085/1062-6050-43.2.222. Wounds to the hands and feet-and anywhere on the head, including the scalp, face, and lips-can be particularly difficult to care for. Monofilament sutures are made of a single strand of material. They also resist infection better than braided suture. 1- Primary Suture Line These sutures can be mentioned … 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 ). Most surgeons believe that wound debridement and irrigation should occur within 6–8 hours, although some would consider 12 hours to be acceptable. Within this method there are numerous variants and the corresponding doctor must choose the most appropriate for the wound presented by the patient. Dissection at the proper depth is facilitated by the use of a single-prong … Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 10 Wound closure and coverage techniques (I), 8 Principles of wound closure and coverage, 10 Wound closure and coverage techniques (II), 10 Wound closure and coverage techniques (III), 10 Wound closure and coverage techniques (IV), 1 Principles of good soft-tissue technique, Manual of Soft-Tissue Management in Orthopaedic Trauma. Clipboard, Search History, and several other advanced features are temporarily unavailable. Click here to Login. It also keeps the wound closed to help prevent infection (it keeps more junk out). In such cases the clean surgical extension may be closed primarily, while the traumatic portion of the wound is often left open for secondary closure. 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