![]() They maintain tensile strength for prolonged periods. Non-absorbable suture materials are preferred for cutaneous wound closure. 2Ĭommonly preferred suture materials for cutaneous lacerations are summarised in Table 1, which lists their characteristics and uses. An alternative means of completing a subcuticular suture is the so-called Aberdeen knot. The emerging suture is then cut flush with the skin. This enables the suture to be locked in position while maintaining its desired tension. To complete closure, the needle is brought out through the skin beyond the apex of the wound, passed back in immediately adjacent to the exit point and brought out at an angle of <90 degrees to the line of the wound. This configuration also facilitates wound edges holding together with the desired suture tension as closure proceeds following by an assistant is usually not necessary. To avoid gaping or puckering in wound closure, successive passes of the suture should be set slightly back from (rather than directly opposite) the exit point of the preceding suture pass on the opposite wound edge. It is especially useful in children where suture removal would prove traumatic. Lacerations should be linear, with clean wound edges and a well-defined dermal layer. This is a running suture effected in a horizontal plane, entirely within the dermis. For longer wounds, an assistant may be helpful to hold the suture with each pass of the needle to maintain the necessary tension. A degree of care is required to ensure good wound edge eversion and minimal gaps in closure. These are useful for rapid haemostatic closure of linear lacerations. With appropriate experience, equally satisfactory wound closure can be achieved with continuous (running) sutures. The figure-of-eight suture can also be applied to small or ill-defined bleeders in subcutaneous fat when electrocautery is not available. It also serves well for haemostasis in highly vascular wounds such as on the scalp, as a result of any small bleeding vessels being gathered up within the encircling figure-of-eight. This cutaneous suture is particularly useful for slightly tense wound edge approximations, as the tension is distributed between two line segments rather than two points. Because they are more time-consuming to perform than simple interrupted sutures, they need only be used for segments of the wound where there is a natural tendency to invert. These cutaneous sutures effectively force wound edges into eversion. In some cases, it may suffice simply to apply adhesive strips to the epidermal layer. If these sutures can efficiently approximate the dermis, a subsequent layer of cutaneous sutures will be under minimal tension, thus reducing the risk of an expanded scar. If possible, the superficial component of the suture should pass through the dermis, as this is the collagen-rich layer on which scar integrity depends. This is achieved by passing the needle from deep to superficial then superficial to deep. This must be done with an absorbable suture in a configuration in which the knot points into the depths of the wound rather than protruding from it. ![]() For deeper wounds, closure of subcutaneous dead space is generally desirable to optimise cosmesis and minimise the risk of wound infection. Although more time-consuming than continuous sutures, they afford better precision when aligning wound edges. This is the most commonly employed suture type for the repair of cutaneous defects. ![]() Useful types of interrupted sutures include: This technique also enables selective early suture removal to allow drainage if a segment of the wound becomes infected, thus obviating a complete wound dehiscence. In most situations, interrupted sutures provide the capacity to make fine adjustments to wound edge approximation and eversion as closure progresses. 1 This article outlines the principles of surgical repair techniques for simple linear lacerations. The essentials of wound assessment and preparation, and the criteria for specialist referral, have been outlined in a companion article on the non-surgical aspects of management. Subsequent aftercare must also be prescribed. Once the wound has been assessed, cleaned and/or debrided, and the need for surgical management identified, decision making is largely centred on the choice of suture techniques and materials. This configuration assures optimal cosmesis. The principal objective of surgical wound closure is to expedite the healing process with good haemostasis and excellent approximation of dermis and epidermis, preferably with eversion of wound edges. Surgical management of lacerations refers to those techniques that necessitate perforation of adjacent uninvolved tissue in order to achieve primary would closure.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |