Principles Of Wound Reconstruction - Primary Closure

Question 1

What are Halsted’s Principles?

Answer 1

Gentle tissue handling

Meticulous control of hemorrhage

Observe strict aseptic technique

Preserve blood supply to tissues

Eliminate dead space

Apples tissues accurately w/minimal tension

Question 2

What is the most typical suture/pattern for fascia/intramuscular closure?

Answer 2

#1 through 3-O USP
Polydioxanone (PDS);
Simple interrupted or continuous

Question 3

What is the most typical suture/pattern for SQ closure?

Answer 3

3-0 and 4-0 USP;
Monocryl, PDS, glycomer 631 (Biosyn);
simple continuous

Question 4

How much does knot volume and tissue reactivity increase when you add 2 extra throws???

Answer 4

By a factor of ~1.5

Question 5

Tension is reduced when wound is closed ______ to the tension lines.

Answer 5

Parallel

EXCEPTION: extremities—>close perpendicular to tension lines

Question 6

What is the simplest technique to relieve tension?

Answer 6

Undermining the tissue

Blunt technique: closed to open blades = opening of blades to separate tissue

Sharp technique: open to closed blades = snipping the tissue w/ the scissor blades as they are advanced through the tissue (more appropriate in the extremities)

Question 7

What is indicated for:
Chronic defects surrounded by inelastic skin and closing wounds near structures that would be distorted by closure under tension (i.e. eye)?

Answer 7

V-Y plastic (provides a flap of skin that can be advanced into a defect to provide tension relief adjacent to an orifice)

Question 8

How should we close circular shaped defects?

Answer 8

By direct linear apposition (results in excessive/redundant tissue at both ends of suture line-“dog ears”)

Or, divide circle into 3 arcs and meet in the middle

Question 9

What is the postoperative analgesia, NOCITA (bupivacaine liposome injectable suspension) labeled for?

Answer 9

Single-dose infiltration into the surgical site to provide local relief for cranial cruciate ligament surgery in dogs!
—>single dose administered during surgical closure may provide up to 72 hours of pain control