Saturday, October 16, 2010

Wound closure

Primary closure

Suturing the wound few hours following the injury less than 6 hours

Can be done provided:

Cut wound with sharp objects
Minimal injury to structure inside
No infection , no contamination
Methods : sutures, staples & adhesive tapes

Delayed primary closure
Surgical closure of a wound within 5 days of the wound having been made
Primary suture within 6 hours is not done because :
gross edema
increased tissue tension
contamination with bacteria

2nd closure
Closure of the wound after granulation tissue is firmly established ( 7-10 days )

Left open
Wound is left open without suturing & dressing is applied. Antibiotic is started
Wound is reexamine 4-6 days later
Heals by 2nd intention

Reconstruction ladder
Skin graft
Local flap
Distant flap
Free flap

Different between skin graft and flaps?
Skin graft (requires vascular bed as it has no blood supply of its own)
Flaps (bring own blood supply to new site)

1. skin graft - in short case, check for the site where the skin is harvest (for example- patient's thigh)

other common site for skin graft?

2. skin flap

different between local and distant flap - A local flap implies that the tissue is adjacent to the open wound in need of coverage, whereas in a distant flap, the tissue is brought from an area away from the open wound.

local flap - uses a piece of skin and underlying tissue that lie near to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply and is repositioned over the wounded area.

Distant flap - uses a section of tissue thatis attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the artery and vein.

Free flap reconstruction also involves the transfer of living tissue from one part of the body to another, along with the blood vessel that keeps it alive. A free flap is a further modification of flap transfer where the flap is entirely disconnected from its original blood supply and then reconnected using microsurgery in the recipient site.

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