Wound closure
A 45yr old farmer presents 18hrs after getting a linear laceration to his right thigh caused by barbed wire. You have extensively irrigated the wound. What is the best closure option?
In delayed primary closure the wound with a high risk of contamination is intentionally left open for 3-5 days., Do regular dressing changes then reassess the wound before consider closing it.
What does it mean to close a wound by "secondary intention"?
This technique is commonly used when you have incised a small abscess, drained it then let it close without any sutures. Also used when you cannot oppose the edges of a wound.
Which of the following statements is TRUE about wound glue?
Wound glue is very useful but needs to be used on the correct wounds. Patients require written instructions about how to care for the wound after instillation. Below is a link to a video by "Dermabond". PS--Don't use it to glue fingers back on.
Which of the following best describes the use of "vertical mattress" sutures?
Vertical mattress sutures involve 2 passess through the wound which results in deep and superficial wound closure.It decreases "dead space" , helps relieve tension and everts the wound edge.
Below is a link showing how to perform a vertical mattress suture.
Which one of the following ants have NOT been documented to be used to close lacerations?
The technique described is similar whichever ant you use.
1/ Press wound edges together. 2/ Guide the ant to be positioned over the wound. 3/ Once the ant bites twist off the thorax leaving the head and jocked jaws which act as a staple.
Below is a link to an animation of Ant stitches.
You decide to close a 2cm laceration in the lower lip which crosses the vermillion border. He is a 36yr old brick layer by trade. What is your most important consideration?
Even a small step off of the vermillion border can be very conspicuous. Use a mental nerve block so you do not have to infiltrate and swell the area.
A 60yr old man has a 10cm linear scalp laceration. There is no underlying fracture. What would be an advantage to using staples rather than sutures.
You certainly do require local anaesthetic. Even though suture material is cheaper than staples cost analyses have shown staples to be overall cheaper than sutures especially when used in long linear lacerations.
A 40yr old lady presents 8hrs after a dog bite to her hand which caused a 4cm puncture / laceration. Examination does not show tendon, joint or neurovascular problems. What is the best option re closure of the wound?
Primary closure is generally avoided in contaminated wounds to decrease the chance of infection.
You decide to use deep dermal sutures to help close a gaping wound on the thigh. What is the advantage of adding absorbable deep dermal sutures in this case?
You close the deeper part of the cut which decreases the skin tension. It also decreases the dead space in the wound which is good because dead space can increase infection.
Which is a contraindication to use the HAT (Hair Apposition Technique) to close a scalp wound?
The Hair Apposition technique is fast , does not generally require local anaesthetic infections and does not require suture removal.
Below is a link to a brief video showing the technique.