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Chapter 42. Wound Closure Techniques

Brent M. Egeland, MD; Paul S. Cederna, MD

  • 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 42–1. Needle characteristics—point.
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Table 42–1. Needle characteristics—point.
CategoryTypeDescriptionTissue UseDiagram
Conventional cuttingTriangular point that changes to a flattened body with one cutting edge on the concave surface of the needle (surface seeking)Skin and tendon
image
Reverse cuttingCutting edge on convex curvature of the needle (depth-seeking) Stronger than conventional cuttingDense tissue, including skin, oral mucosa, and tendon
image
CuttingSide-cutting (spatula)Flat with 2 cutting edge to reduce tissue injury and improve depth controlOcular tissues
image
Taper-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 peritoneum
image
BluntBluntDissects through tissue rather than cutting itFriable tissue, including kidney and liver
image
Table 42–2. Needle Characteristics—body.
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Table 42–2. Needle Characteristics—body....
TypeNotesDiagram
StraightUsed in easily accessible tissue

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