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Small Animal Surgery > Wound Closure > Flashcards

Wound Closure Flashcards

1
Q

What is primary wound closure?

A

Immediate closure of clean and clean-contaminated wounds

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2
Q

What do you want to minimize with closure?

A

Dead space

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3
Q

What is delayed primary wound closure?

A

Wound left ope for 2-5 days, but closed prior to visible granulation

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4
Q

Why would you use delayed primary closure?

A

If repeated lavage and debridement is necessary to convert to a clean-contaminated wound.

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5
Q

What is secondary closure?

A

Wound closure AFTER granulation tissue covers the wound.

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6
Q

Describe secondary closure with a deep, narrow wound.

A

Direct apposition over granulation tissue.

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7
Q

Describe secondary closure with a wide wound.

A

Mobilize skin edges and advance over granulation tissue.

NOTE: Dr. Pope will remove granulation tissue is he has enough skin to cover the wound.

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8
Q

What is second intention healing?

A

Contraction and granulation where granulation tissue is laid down and the wound contracts and gains an epithelial layer.

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9
Q

How well will a distal limb wound that is 25-33% the circumference heal?

A

Most heal well

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10
Q

How well will a distal limb wound that is 33-50% the circumference heal?

A

Probably heal, but with a wide scar. Consider facilitating closure.

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11
Q

How well will a distal limb wound that is >50% the circumference heal?

A

Consider reconstruction.

Extended heal time

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12
Q

What are 3 things that cause cessation of wound contraction?

A

Wound has healed
Tension exceeds pull of myofibroblasts
Collagen interferes with pull of myofibroblasts

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13
Q

What are 2 complications of second intention healing?

A

Epithelium is not very thick or adhered to the tissue below (bleeds and comes off easily)
Circular wounds just don’t heal well.

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14
Q

What is wound contracture?

A

Scar tissue formation that interferes with normal function .

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15
Q

When considering skin tension lines, do you want to cut parallel or perpendicular to the lines?

A

Parallel to the line ha less tension on the wound and allows for better healing.

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16
Q

If you have multiple suture lines meeting, how do you reduce the chance of necrosis?

A

Use an intradermal bite on the point to help edges meet up better.

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17
Q

If you have a wound with unequal sides lengths, how do you suture to help minimize “dog ears”?

A

Place sutures closer together on the short side, and farther apart on the long side.

18
Q

What is primary contraction?

A

Retraction of the skin edge after tissue is cut.

19
Q

What is a major concern with a patient that has a large, exudative wound?

A

Protein loss via exudate. Initial thought is to make wound smaller at least to minimize loss.

20
Q

What 2 things influence ability to undermine skin?

A

Species (differences in blood supply)

Breed (loose skin vs. tight skin)

21
Q

Under what structure should you be working to undermine skin and why?

A

Cutaneous trunci muscle, helps maintain good blood flow.

22
Q

Why is it important to use blunt dissection when undermining skin?

A

Preserves direct cutaneous vessels

23
Q

What happens to skin that has been pulled over to close a wound?

A

Tension results in stretching of the skin.

24
Q

What are 3 purposes of a walking suture?

A

To advance/stretch skin over a wound
To distribute tension on the skin (helps avoid dehissance)
Decrease dead space

25
Q

What type of suture would you use in a walking suture?

A

Absorbable monofilament

26
Q

What must sutures engage to have enough holding power?

A

Dermis and fascia

27
Q

What are 4 techniques for enhancing local skin movement?

A

Skin stretching
Releasing incisions
Multiple punctate relaxing incisions
Adjustable horizontal mattress sutures

28
Q

What are 3 ways to stretch skin?

A

Skin expanders
Skin stretching devices (helps facilitate closure)
Presutureing

29
Q

What is the purpose of presuturing?

A

Takes advantage of creep and stress relaxation of the skin

30
Q

What does presuturing involve?

A

Mattress sutures with stents to distribute pressure

31
Q

How long does the presuturing usually remain in place?

A

Usually <24 hours (placed day before surgery)

32
Q

What are the 4 classifications of wound closure?

A

Primary
Delayed primary
Secondary
Contraction and Epithelialization (Second intention)

33
Q

How well will a distal limb wound that is <25% circumference heal?

A

Should heal well

34
Q

What is a good use for presuturing?

A

If you need to avoid making an incision over a pressure point like a joint, can stretch the skin beforehand so incision can be made to the side of the pressure point.

35
Q

Why do you make multiple punctate relaxing incisions?

A

If skin edges of primary wound wont come together even after stretching.

36
Q

What are the 3 steps to placing multiple punctate relaxing incisions?

A

Undermine skin
Place intradermal suture pattern
Make rows of staggered, full-thickness incisions (keep tension on intradermal suture

37
Q

Isn’t it stupid to make MORE wounds with multiple punctate relaxing incisions that to just fix the primary wound?

A

Nope. Will aid in closure of primary wound, and secondary wounds will heal better than the primary wound would have.

38
Q

When does adjustable horizontal mattress work best?

A

In wounds with established granulation tissue.

NOTE: reason is because skin edge is thicker and holds suture better

39
Q

What materials do you need to do an adjustable horizontal mattress?

A

Monofilament suture
Buttons
Split-shot

40
Q

What are the 3 steps to placing an adjustable horizontal mattress?

A

Continuous intradermal suture pattern
Buttons and split shot placed at one or both ends
Tighten suture each day to enhance wound closure

Small Animal Surgery (13 decks)

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