1. Wound closure

2. Ensures optimal healing
Aesthetic closure
knowledge of healing mechanisms
skin anatomy
suture material and closure technique
Ensures optimal healing

3. Three distinct phases Inflammation tissue formation tissue remodeling
inflammatory cells into the wound
inflammatory phase occurs in the first few days as inflammatory cells migrate into the wound
tissue formation
epithelial cells has been shown to occur within the first hours
further new tissue formation occurs over the next days
tissue remodeling
wound contraction and tensile strength is achieved
occurs in the next 6-12 months

6. Affect wound healing
systemic illness
local factors

7. Two types of wound healing
primary intention
surgical wound closure facilitates the biological event of healing by joining the wound edges
minimize new tissue formation
elimination of dead space by approximating the subcutaneous tissues
minimization of scar formation by careful epidermal alignment
avoidance of a depressed scar by precise eversion of skin edges
secondary intention
spontaneous healing

9. Suture materials

10. absorbable and nonabsorbable
natural and synthetic
synthetic materials
less reaction
less inflammatory reaction
absorbable and nonabsorbable
nonabsorbable sutures offer longer mechanical support
monofilament and multifilament
monofilaments have less drag
Infection is avoided

11. Absorbable suture materials
lose tensile strength before complete absorption
gut last 4-5 days in terms of tensile strength
chromic form, gut can last up to 3 weeks
Vicryl and Dexon
maintain tensile strength for 7-14 days
complete absorption takes several months
Maxon and PDS
long-term absorbable sutures
lasting several weeks
requiring several months for complete absorption

12. Nonabsorbable sutures
silk has the lowest strength
nylon has the highest

13. Suture technique

15. Running, or continuous stitch
made with one continuous length of suture material
close tissue layers which require close approximation
speed of execution, and accommodation of edema during the wound healing process
greater potential for malapproximation of wound edges with the running stitch than with the interrupted stitch

16. needle at a 90° angle to the skin within 1-2 mm of the wound edge and in the superficial layer
exit through the opposite side equidistant to the wound edge and directly opposite the initial insertion

18. Interrupted stitch stitch is tied separately
used in skin or underlying tissue layers
more exact approximation of wound edges can be achieved with this technique than with the running stitch

20. Mattress suture
a double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge
advantage of this technique is
strength of closure
each stitch penetrates each side of the wound twice
inserted deep into the tissue

22. Purse string
continuous stitch paralleling the edges of a circular wound
wound edges are inverted when tied
used to close circular wounds, such as hernia or an appendiceal stump

24. Smead-Jones/Far-and-Near
a double loop technique alternating far and near stitches
greater mechanical strength than continuous or simple interrupted sutures
used for approximating fascial edges, especially for patients at risk for fascial disruption or infection

26. Continuous Locking, or Blanket Stitch
a self-locking running stitch used primarily for approximating skin edges

27. good approximation edges is paramount to proper wound closure technique
deep sutures serve to eliminate the dead space and relieve tension from the wound surface
deep sutures also ensure proper alignment of the wound edges and contribute to their final eversion
wound closure may require sharp undermining of the tissues to minimize tension on the wound
achieve hemostasis
eversion of all skin edges avoids unnecessary depression of the resultant scar

28. Immediate and delayed complications may occur with wound closure
immediate complications
formation of hematoma
wound infectionp
prophylactic antibiotics
late complications
scar formation
excess tension
lack of eversion of the edges
hypertrophic scarring and keloid formation\
stitch marks
wound necrosis

29. Suture removal face: 3-4 days scalp: 5 days trunk: 7 days
arm or leg: 7-10 days
foot: days

30. Thanks for your attention !!!