Fig. 13.1
Wound closure with elimination of dead space. Note the elimination of any dead space in the wound
13.3 Techniques
A few simple rules promote the opportunity for a success wound closure:
1.
Clean and dry, well-controlled hemostasis and removal of tissue debris and clot
2.
Adequate room for implanted devices
3.
Elimination of dead space
4.
Appropriate technique for closure of skin
There are as many closure techniques as individuals doing them. Excellent outcomes are produced by attention to detail. The authors have spent many years using these techniques; experience, empirical study, and anecdotal observation have proven their worth in the low complication rate and high degree for success. Consideration of type of stitch employed and choice of suture used (Table 13.1), along with type of needle (Fig. 13.2), improve the chance for desirable outcomes.
Table 13.1
Characteristics of common absorbable and non-absorbable sources
Suture | Surgical gut | Surgical gut | Polyglycolic acid (PGA) | Rapid polyglycolic acid (RPGA) | Silk | Nylon | Polypropylene |
|---|---|---|---|---|---|---|---|
Types | Plain | Chronic | Braided | Braided | Braided | Monofilament | Monofilament |
Common material color | Yellowish tan | Blue | White | Undyed (beige) | Black | Black | Blue |
Raw material | Collagen from beef and shrimp | Collagen from beef and shrimp | Lactide and glycolide co-polymer | Lactide and glycolide co-polymer | Organic protein (fibroin) | Long-chain aliphatic polymers | Long-chain polyolefin polymers |
Tensile strength | Low | Low | High | High | Moderate | Moderate | High |
Tensile strength (in vivo) | 3–5 days | 7–10 days | 28–35 days | 10–14 days | Progressive degradation of fiber results in gradual loss of tensile strength | Progressive hydrolysis results in gradual loss of tensile strength | No significant changes known to occur in vivo |
Tissue inflammatory reaction | Moderate | Moderate | Minimal | Minimal | Mild to moderate | Minimal | Minimal |
Indications/contraindications | Exhibit mild tensile strength. Used for approximating tissues with little tension Absorbable and should not be used where extended approximation of tissues under stress is required
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