Aesthetic closure knowledge of healing mechanisms skin anatomy suture material and closure technique
Ensures optimal healing
Three distinct phases Inflammation
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 12-24 hours
further new tissue formation occurs over the next 10-14 days tissue remodeling
wound contraction and tensile strength is achieved occurs in the next 6-12 months
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 subcutane
ous tissues minimization of scar formation by careful epidermal align
ment avoidance of a depressed scar by precise eversion of ski
n edges secondary intention
spontaneous healing
natural and synthetic synthetic materials
less reaction less inflammatory reaction
absorbable and nonabsorbable nonabsorbable sutures offer longer mechanical su
pport monofilament and multifilament
monofilaments have less drag Infection is avoided
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
Running, or continuous stitch made with one continuous length of suture materia
l close tissue layers which require close approxim
ation 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
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
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
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
Purse string continuous stitch paralleling the edges of a
circular wound wound edges are inverted when tied used to close circular wounds, such as h
ernia or an appendiceal stump
Smead-Jones/Far-and-Near a double loop technique alternating far and
near stitches greater mechanical strength than continuo
us or simple interrupted sutures used for approximating fascial edges, es
pecially for patients at risk for fascial disruption or infection
Continuous Locking, or Blanket Stitch a self-locking running stitch used primarily
for approximating skin edges
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 depr
ession of the resultant scar
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