Wound Closure
Healing by Primary intention:
- Skin apposed
- Layers correct
- No strangulation
- No infection
- No foreign body
- Correct suture
Remember it is important to close together the deeper tissue layers with a resorbable suture. This will prevent haematoma formation and subsequent abscess formation, with a marked delay in healing.
Healing by Secondary intention:
- Clot in gap
- Granulation tissue
- Myofibroblasts
- Collagen
This situation results in SCAR TISSUE
The difficult areas are:
- Scalp - Commence in the hair – look carefully for bleeding areas. It is only occasionally necessary to remove some hair if there is a ragged laceration. The scalp is very vascular and so it is important to assess bleeding points and obtain haemostasis. Local anaesthetic with a vasoncontrictor can be infiltrated in to the wound edges using a narrow needle or dental needle and syringe. Rarely bleeding may require diathermy and a hand-held pen diathermy may be useful if available.
- Eyebrow – Do not shave the eyebrow or cut away any tissue. The face has an excellent blood supply and even the most ragged tissue can be saved.
- Lip – If the laceration goes through the lip, the important area here is the vermillion border – “the red line” It is imperative that this red line is aligned first. If the laceration is full thickness, then once the vermillion border/line is re-established the wound can be closed.
- Ear – the issue here is the prevention of a haematoma –“Cauliflower ear” and drainage is important with adequate pressure. It is important to put gauze in front of and behind the pinna post drainage and to hold this in place with a head bandage on. This will minimise the risk of cartilage necrosis.
Realign do not shave
- The knot
Remember when tying a knot to give two turns in one direction and then one turn in the opposite direction
Aim for:
- In at 90 degrees
- Pass needle in natural curve
- Mirror on other side
- Levels correct
- Out at 90 degrees
- Lay knot on one side
- Adjust tension to evert mildly, never invert
- How to remove
This is important, as it is vital not to pull dirty material through the skin.