Chapter 42. Wound Closure Techniques

• 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.