L07: Skin and Fascial Wound Closure (Morton) Flashcards Preview

Surgery (Spring 2015) > L07: Skin and Fascial Wound Closure (Morton) > Flashcards

Flashcards in L07: Skin and Fascial Wound Closure (Morton) Deck (30):
1

layers encised in celiotomy (ventral midline incision)

skin
SC tissues
linea alba (aponeurosis of rectus abdominis muscles)
retroperitoneal fat
peritoneum
*linea alba and external rectus abdominis fascia are the holding layers to prevent herniation/peritonitis*

2

General guidelines

incise with scalpel to minimize trauma
avoid tangental incisions
avoid incisional trauma

3

fascial closure cranial to umbilicus

take full thickness bites of linea

4

fascial closure caudal to umbilicus

SA: take wide bites of external rectus fascia
LA: full thickness bites
*avoid large bites of muscle to reduce inflammation and associated risks*

5

suturing of peritoneum

-does not contribute to wound strength
-INCREASES risk of adhesions
-healed by mesothelial cells in 3 days
-do not suture!

6

Pros of CONTINUOUS fascial closure pattern

dec. time, suture material
similar strength as interrupted
higher bursting strength than interrupted

7

Cons of CONTINUOUS fascial closure pattern

-one break can --> herniation
-suture material usually fails at knots
-closure usually fails at body wall

8

how many throws needed at start and end of continuous pattern?

5 at start, 7 at end due to loop, which has decreased knot security

9

Cons of INTERRUPTED fascial closure pattern

-slower
-increased suture material
-4+ throws/knot

10

General recommendations for suture materials for fascial closure

-non-reactive monofilament
-absorbable
-PDS, Maxon, Vicryl in horses, all good choices
-long retention of tensile strength
-non-absorbable when slow healing anticipated (stainless steel, nylon)
-bites 0.5-1cm from incision, 0.4-1cm apart

11

suture size for fascial closure of body wall vs. body weight***

40kg: 1
Horse: 3

12

"subcuticular" skin closure includes:

dermis and subcutis

13

"intradermal" skin closure includes:

dermis only

14

"subcutaneous" skin closure includes:

subcutis only
-NOT a holding layer; must also close another layer more superficially

15

subdermal plexis includes:**

subcutis, fascia, muscle

16

layers of skin

epidermis
dermis
subcutis
fascia
muscle

17

general guidelines for skin closure

-incise parallel to lines of tension (Langer's lines)
-keep tissue hydrated
-avoid undermining (creates dead space)
-avoid excessive manipulation (fingers, skin hook or needle, fine toothed forceps acceptable)

18

what determines scar width?

subcutaneous closure

19

what suture patterns used for SC closure

interrupted or continuous

20

"tacking down" SC sutures

take a bite every 4-5 sutures down to external rectus fascia
-only use if excessive dead space because potential to seed any infection deeper down

21

ideal suture material for SC closure

-non-reactive (monofilament or braided)
-absorbable
-doesn't need prolonged tensile strength
-PDS, Vicryl, Maxon, Monocryl good
-smaller diameter than used in linea

22

what suture patterns are used for cutaneous?

Cruciate (increased speed, tension relief)
Simple interrupted (dec. speed, can adjust tension more precisely, gets more perfect closure)
Continuous (simple or Ford interlocking; rarely used because of increased irritation)

23

spacing of cutaneous sutures

3-8mm from incision
5-10mm apart

24

ideal suture material for cutaneous closure

-MONOFILAMENT
-non-absorbable or absorbable
-reverse cutting needle
-Nylon, Prolene, Fluorofil good

25

Pros of intradermal skin closure

no suture removal
cosmesis

26

Cons of intradermal skin closure

technically difficult
time consuming
doesn't eliminate dead space
dec. resistance to tension

27

indications for intradermal skin closure

clean wound
healthy patient
minimal to no tension
mass removal or elective spay/neuter

28

ideal suture material for intradermal skin closure

-absorbable monofilament or braided
-vicryl, PDS, monocryl
-small diameter
-reversed cutting needle

29

intradermal skin closure pattern technique

-4 throws "Deep to Sup, Sup to Deep"
-bury knot at beginning and end
-start on near side of incision
-bites at even depth
-don't advance b/w bites

30

Staples: pros and cons

cons: inc. cost, not suited for wounds under tension or thin skin
pros: dec. operative time which ultimately does save money