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  • Surgical wounds.
  • Traumatic wounds.

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Absolute

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  • Multiple comorbidities precluding safe intervention.
  • Active infection.
  • Foreign body (except surgical implants).
  • Active bleeding.

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Relative

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  • Impaired healing (corticosteroids, malnutrition, radiation, chronic disease).

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  • Usually implied with consent for major procedure, must obtain consent otherwise.

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Potential Risks

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  • Scarring (normal and abnormal).
  • Bleeding (may require reoperation or transfusion).
  • Infection (may require antibiotics or reoperation).
  • Failure of operation or need for secondary intention healing.
  • Need for revision.

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Instruments

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  • Appropriate instruments vary by wound type but include at a minimum a needle driver and tissue handling forceps.

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Sutures

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  • Consist of both a needle and suture material, each with multiple subtypes and characteristics.
  • The needle and suture material may vary widely based on different types of wounds in different locations.

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Needle

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  • Table 42–1: Point characteristics.
  • Swage: the method of attaching the suture material to the needle.
    • Channel swage: a channel is crimped over suture material (swage diameter > body diameter).
    • Drill swage: suture material is placed in the drill hole at the rear of needle, which is then crimped (swage diameter < body diameter).
    • Nonswaged: eyed needle (similar to sewing needle). Closed-eye needles require suture material to be passed through the eye each time it is threaded. French eye needles have a posterior slit allowing suture to be placed in the eye without direct threading; this causes more tissue trauma and reduced suture integrity (eye > body diameter).
    • Pop-off: swage is designed to allow suture material to be gently removed from the needle with traction.
  • Table 42–2: Needle body characteristics.
    • Designed to transmit the penetrating force to the point.
    • Varied alloy characteristics can make a needle soft or firm (ductility).
    • Diameter: gauge or thickness of needle.

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Table Graphic Jump Location
Table 42–1. Needle characteristics—point.
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Table Graphic Jump Location
Table 42–2. Needle Characteristics—body.

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