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
– hematoma
– contamination with bacteria

◙2^nd 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 2^nd intention

Reconstruction ladder
- Suturing
- 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.