Canis ISSN: 2398-2942

Wound closure: primary

Contributor(s): Daniel Smeak

Introduction

  • Closure techniques suitable for clean wounds with or without tension or a skin defect. Clean wound is defined as a wound created under aseptic conditions, no gross contamination occurred, no foreign material or active inflammation is present.

Uses

Suitable patterns for primary skin closure (interrupted patterns recommended in motion or tension areas)

  • Simple interrupted.
  • Simple continuous.
  • Intradermal.
  • Ford interlocking.
  • Cruciate.
  • Vertical mattress.
  • Horizontal mattress.

Means of reducing minor skin tension

  • Patient positioning.
  • Subcutaneous or subcuticular sutures.
  • Undermining.
  • Tension relieving sutures:
    • Alternating large vs small bites of skin in interrupted sutures.
    • Walking sutures are particularly useful for decreasing tension across an undermined flap.
    • Near-far-far-near.
  • Retension sutures:
    • Buttons or tubing (stents) can be used with a secondary line of mattress sutures to reduce tension on primary skin closure.

Advantages

Primary closure

  • Eliminates need for repeated bandaging of wound.
  • Results in the most cosmetic wound.
  • Minimal contraction of wound and minimal scar formed.
  • Results in a mechanically sound skin surface vs wounds left to heal by second intention.

Disadvantages

Primary closure

  • Closure of wounds before wound conditions condusive to healing will result in dehiscence and infection.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Depends on condition of wound - if conditions appropriate, most primarily closed wounds heal uneventfully.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Devitt C M, Seim H B 3rd, Willer R et al (1997) Passive drainage versus primary closure after total ear canal ablation-lateral bulla osteotomy in dogs - 59 dogs (1985-1995). Vet Surg 26 (3), 210-216 PubMed.
  • Johnston D E (1990) Care of accidental wounds. Vet Clin North Am Small Anim Pract 20 (1), 27-46 PubMed.

Other sources of information

  • Placing walking sutures. dvm360: www.youtube.com/watch?v=l6KJetS73nE.
  • Pavletic M M (1993) Atlas of Small Animal Reconstructive Surgery. Philadelphia: J B Lippincott Company.


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