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Flashcards in 77. tension relieving Deck (14):

halsteads 7 principles

1. asepsis2. gentle tissue handling3. meticulous hemostasis4. maintain blood supply5. obliterate dead space6. accurate apposition7. tension free closure


two consequences of skin closed with approximation and too tight of sutures

1. suture cut out2. biologic tourniquet


recommendation for closing wound in relation to tension lines

PARALLEL to tension lines/ Langer lines


skin properties inherent to its viscoelastic nature

1. pliability2. returns to original shape (plasticity) when load is removed3. ability to adapt when prolonged stress is applied (mechanical creep and stress relaxation)


list techniques to alleviate tension

1. undermine2. tension relieving sutures 3. skin stretching4. relax/releasing incisions


at what level should undermining tissues occur at

DEEP to cutaneous trunci muscle to preserve to subdermal plexus (deep plexus) which arborizes and perfuses the dermis


principle behind tension relieving sutures

to alleviate tension on the primary suture line and to distribute it over a larger areaminimizing "cut out suture"


types of tension relieving suture patterns

1. strong SQ interrupted sutures (FFNN, FNNF, cruciate)2. stent sutures (bolster, perpendicular to incision 2 cm away placed before closure of primary defect--NOT BUTTONS)3. FFNN, FNNF (relieves-F and approximates-N)4. mattress (horizontal--may compromise blood supply, vertical--better with stents, may evert)


skin stretching techniques

Allow for creep of skin (elongate) over time will lose it tendency to recoil (stress relaxation)1. pretensioning sutures and pre suturing 24-72 hrs before sx (mechanical creep)2. acute intraop skin stretching skin hooks, towel clamps, stay sutures3. intraop walking sutures (dermis to underlying fascia)4. skin expanders for chronic skin wounds (biologic creep)5. relaxing incisions (1 cm spacing, parallel, single/multiple/V-Y/Z/M)


difference btwn pretension and presuture

pretension is over an existing woundpresuture is over an area of planned excision


ways to pretension/presuture

1. continuous suture line with monofilament2. continuous horizontal intradermal3. skin stretching with velcro4. lembert interrupted sutures over areacan add lead spit shot compressed over suture ends of deep loop when suture loosens from stress relaxation and need to tighten for pretension


skin expanders to relieve tension

NOT for acutely traumatized skin but rather for chronic or delayed recon effortutilizes biologic creepinflatable or expandable silicone device placed in SQ and expanded by 10-15% q48-72 hours (total 100 ml)


T/Fa simple relaxing incision is also called a bipedicle flap

trueincision created parallel to long axis of defectlength and width equivalent to length and width of woundlength to width ratio should NOT exceed 4:1relaxing incision will heal via second intention


types of relaxing incision

1. multiple mesh2. single or double simple (bipedicle flap)3. V-Y (V points away from defect)4. Z plasty (central arm perpendicular to long axis defect)5. M plasty (close in Y)

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