Expected complications of surgery
Inflammation Edema Stretching Dehiscence Increased risk of infxn Scarring
Keloid scar
Develops outside of normal incision site
More common when incisions are made across Langer’s lines
Hypertrophic scar
Stays within incision site but grows bigger within the site
Abscess scalpel type
11
Shave biopsy scalpel type
10 or a derma blade
What is the tension at a wound 10-14 days after a closure?
5-6% of strength
What is the tension at a wound 1 month after closure?
30-40% of strength
When do you use 1/100,000 epi?
Typical procedures
When do you use 1/10,000 epi?
Anaphylaxis IV
When do you use 1/1000 epi?
IM
How much epi do you inject?
0.3 cc
Why do we perform corner stitches?
Decreases the chance of compromising circulation
What is in biopsy containers to preserve the sample?
10% formalin
Use horizontal and vertical mattress sutures when..
elliptical removal with a lot of tension
Why do we use langers lines?
- reduces scarring
- reduces tension
- improves healing time
Delayed closure time frame
4 days or 96 hours if there are no signs of infxn
Laner’s lines
correspond to natural orientation of collagen fibers in the dermis and parallel to the orientation of the underlying muscle fibers
Three phases of healing
- inflammatory: immediate-2-5 days. bleeding stops. inflammation.
- proliferative: 5 days-3 weeks. granulation. contraction. epithelialization.
- maturation: 3 weeks-2 years. collagen forms which increases tensile strength to wounds.
Four groups of wounds
- clean
- clean-contaminated
- contaminated
- dirty and infected
Primary (first) intention
- Start with a clean wound
- Close promptly
- produce minimal edema
- have no local infxn
- have no serious discharge
- heal in a minimum of time
- heal w/ good skin edge approximation and eversion
- heal with minimal scar formation
2 scenarios of secondary intention
- wound hails to heal via primary intention due to excessive tissue trauma and/or loss, imprecise approximation of tissues
- wound is left open on purpose (a “paper cut”, abrasion or draining and abscess). Wound allowed to heal w/o closure, heals from inner layers towards the surface (“granulation from below”)
Pros of secondary intention
simple
relatively low risk of infxn
Cons of secondary intention
- may take a long time to heal
- tends to cause larger scars
What size sutures for hand wounds?
4-0 or 5-0
