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).

• The wound should be fully exposed and at comfortable working distance from the surgeon.
• A light source is often necessary in the emergency department setting.

• Wound edges should remain clean.
• Sutures should be removed several days (typical in face) or weeks following repair, depending on the location of the wound and characteristics of the tissue.
• Pain control with analgesics is appropriate.
• Antibiotics are not necessary for most wounds but may be recommended in contaminated wounds following closure.

• Wound infection.
  • Infected wounds, particularly those involving deep spaces, are typically opened to prevent systemic spread.
• Unfavorable scarring.
  • Some scarring is expected, but hypertrophic scars, keloids, or wound contraction leading to functional limitation may occur, often without a known cause.
  • Some wounds with unfavorable scarring may require scar revision.
• Standing cutaneous deformities ("dog ears") may be a result of individual wound length differences leading to excess tissue on one side of the wound, or occur in cases in which tissue rearrangement is necessary to achieve closure.
  • These cutaneous deformities may persist and can often be addressed at primary closure.
  • To remove a standing cutaneous deformity, the tissue leading to the deformity can be lifted away from the plane of tissue and resected in an elliptical fashion.
  • If executed properly, the dimensions of the newly created ellipse will allow primary closure without a standing cutaneous deformity.