Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Surgical wounds.Traumatic wounds. +++ Absolute ++ Multiple comorbidities precluding safe intervention.Active infection.Foreign body (except surgical implants).Active bleeding. +++ Relative ++ Impaired healing (corticosteroids, malnutrition, radiation, chronic disease). ++ Usually implied with consent for major procedure, must obtain consent otherwise. +++ Potential Risks ++ 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. +++ Instruments ++ Appropriate instruments vary by wound type but include at a minimum a needle driver and tissue handling forceps. +++ Sutures ++ 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. +++ Needle ++ 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. ++Table Graphic Jump LocationTable 42–1. Needle characteristics—point.View Table||Download (.pdf)Table 42–1. Needle characteristics—point.CategoryTypeDescriptionTissue UseDiagramConventional cuttingTriangular point that changes to a flattened body with one cutting edge on the concave surface of the needle (surface seeking)Skin and tendonReverse cuttingCutting edge on convex curvature of the needle (depth-seeking) Stronger than conventional cuttingDense tissue, including skin, oral mucosa, and tendonCuttingSide-cutting (spatula)Flat with 2 cutting edge to reduce tissue injury and improve depth controlOcular tissuesTaper-point (round needle)Stretches tissue without direct cutting action to minimize tearing Sharpness increases with taper ratio (slope) (8–12:1) and decrease with tip angle (20–35 degrees)Easily penetrated tissues, including abdominal viscera, dura, and peritoneumBluntBluntDissects through tissue rather than cutting itFriable tissue, including kidney and liver++Table Graphic Jump LocationTable 42–2. Needle Characteristics—body.View Table||Download (.pdf)Table 42–2. Needle Characteristics—body.TypeNotesDiagramStraightUsed in easily accessible tissue... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.