Primary closure is defined as the surgical closure of a wound in one or more layers, within hours of its occurrence. Most surgical incisions and traumatic lacerations are closed primarily. Delayed primary closure is the surgical closure of a wound, days to weeks later. The granulation tissue is excised, the edges of the wound are freshened and the wound is closed. An example of this method is the closure of a fasciotomy incision.
Skin grafting is indicated when a defect is too large to close primarily, and creation of flaps is not desirable or feasible. It may be performed instantly following the injury or in a delayed manner. Surgical flaps allow the recruitment of local or distant tissue for wound coverage.
Healing by secondary intention is the option a surgeon is left with when a wound cannot be surgically repaired. This doesn’t mean that the surgeon can leave the wound to heal on its own; every day care and a long-term commitment by the patient and the care-givers are needed.
The wound must be kept clean and bacterial colonization should be minimized by every day washing, debridement of necrotic tissue and antibiotics when indicated. Healing by secondary intention involves the wound’s progression via granulation tissue formation, epithelialization and contraction.
The commonly utilized suturing techniques are described here. Some essential points are applicable to all of the strategies. The tissue should be entered as close to 90° as possible. The path of the needle should follow its curve. The suture should be pulled forward through the tissue as gently as feasible. These actions will help minimize trauma to the tissues.
Easy interrupted sutures are used to achieve optimal wound edge alignment. This method is fast and easy to master. It is perfect for most traumatic lacerations. Nylon sutures are commonly used. Knots ought to by no means be tied tightly since the tissue can swell and undergo pressure necrosis under the suture.
Continuous running closure is probably the most rapid suturing method; nevertheless it is difficult to attain precise edge alignment when tension is present. In tension-free regions it can be used with a good cosmetic result. It's helpful for achieving hemostasis. If extra hemostasis is needed, the stitch can be locked.
Vertical and horizontal mattress sutures offer great wound edge eversion. They're an excellent choice for use in the hands and feet, or in areas of high skin tension. Half-buried mattress sutures are useful for closing V-shaped wounds. The mattress portion is horizontal, and the buried portion is placed in the dermis of the tip in order to prevent necrosis of the tip of the V.
Subcuticular sutures are running, intradermal sutures that can offer an excellent cosmetic result by eliminating any surface sutures and the potential epithelial tracking that can result in a permanent suture mark. PDS or other absorbable sutures with low reactivity can be utilized if suture removal is problematic, like in young children. If suture removal is an choice, Prolene is a good option since it has minimal tissue reactivity and should be left in location for 2-4 weeks.
Buried, deep dermal sutures are utilized to decrease skin-edge tension and to allow the superficial closure to be done as tension-free as possible. Usually, absorbable sutures like Vicryl are used in an interrupted manner to close the deep dermis.
Staples are useful for closing wounds in a variety of situations, like lacerations or incisions of the scalp. The main advantage that staples provide is that they offer the quickest technique of incision closure, and they produce minimal tissue reactivity if removed within a week. Nevertheless, if left in place too lengthy, staples will produce a characteristic “railroad-track appearance” because of migration of epithelial cells down the tract created by the staples. In addition, precise wound edge alignment is difficult to achieve with staples.
Staples should not be used on visible sites like the face and neck. They are suitable for use in reconstructive cases in which precise wound closure is of lesser importance. They can be removed as early as 7 days in straightforward, tension-free closures, or they may be left in place for several weeks if suboptimal wound healing is expected.
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1. The consultation prior to the cosmetic surgery of the breast
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