Wound Closure Flashcards
(40 cards)
What is primary wound closure?
Immediate closure of clean and clean-contaminated wounds
What do you want to minimize with closure?
Dead space
What is delayed primary wound closure?
Wound left ope for 2-5 days, but closed prior to visible granulation
Why would you use delayed primary closure?
If repeated lavage and debridement is necessary to convert to a clean-contaminated wound.
What is secondary closure?
Wound closure AFTER granulation tissue covers the wound.
Describe secondary closure with a deep, narrow wound.
Direct apposition over granulation tissue.
Describe secondary closure with a wide wound.
Mobilize skin edges and advance over granulation tissue.
NOTE: Dr. Pope will remove granulation tissue is he has enough skin to cover the wound.
What is second intention healing?
Contraction and granulation where granulation tissue is laid down and the wound contracts and gains an epithelial layer.
How well will a distal limb wound that is 25-33% the circumference heal?
Most heal well
How well will a distal limb wound that is 33-50% the circumference heal?
Probably heal, but with a wide scar. Consider facilitating closure.
How well will a distal limb wound that is >50% the circumference heal?
Consider reconstruction.
Extended heal time
What are 3 things that cause cessation of wound contraction?
Wound has healed
Tension exceeds pull of myofibroblasts
Collagen interferes with pull of myofibroblasts
What are 2 complications of second intention healing?
Epithelium is not very thick or adhered to the tissue below (bleeds and comes off easily)
Circular wounds just don’t heal well.
What is wound contracture?
Scar tissue formation that interferes with normal function .
When considering skin tension lines, do you want to cut parallel or perpendicular to the lines?
Parallel to the line ha less tension on the wound and allows for better healing.
If you have multiple suture lines meeting, how do you reduce the chance of necrosis?
Use an intradermal bite on the point to help edges meet up better.
If you have a wound with unequal sides lengths, how do you suture to help minimize “dog ears”?
Place sutures closer together on the short side, and farther apart on the long side.
What is primary contraction?
Retraction of the skin edge after tissue is cut.
What is a major concern with a patient that has a large, exudative wound?
Protein loss via exudate. Initial thought is to make wound smaller at least to minimize loss.
What 2 things influence ability to undermine skin?
Species (differences in blood supply)
Breed (loose skin vs. tight skin)
Under what structure should you be working to undermine skin and why?
Cutaneous trunci muscle, helps maintain good blood flow.
Why is it important to use blunt dissection when undermining skin?
Preserves direct cutaneous vessels
What happens to skin that has been pulled over to close a wound?
Tension results in stretching of the skin.
What are 3 purposes of a walking suture?
To advance/stretch skin over a wound
To distribute tension on the skin (helps avoid dehissance)
Decrease dead space
