As a general rule, wounds are either closed secondarily or primarily.
Primary wound closure: is one that is operated upon the wound within a short time of its occurrence. The suturing takes little cleaning and preparation which is probably why this type is more popular when it comes to wound suturing.
Secondary wound closure: is one that is used to suture the wound which hasn’t been closed properly, or there has been a delay in its closure for up to a couple of days since the occurrence of the wound. this type requires a more complicated procedure to carry out as they have to be meticulously cleaned first.
Primary or secondary; which to choose and when
Wounds that are about 6 to 14 hours old, can be closed using the primary method however this will be only if the wound is not infected. In such a case, the wound must be cleaned and treated accordingly to remove any traces of an infection before performing the suturing.
On the other hand, wounds that are at least 14 to 24 hours old, shouldn’t be closed primarily.
Signs that show when not to use primary method:
- Reddening around the wound spreads
- Discharge of pus from the wound
- A constant high temperature
- When there’s a mass of soft gaping tissue
To clear the wound, 3 to 7 days of aseptic care is needed, along with warm dressings and irrigations. Only then, should secondary wound closure be attempted.
The most important part of a good suturing technique is whether the knot tying method of the suture is correct or not. There are various types of knots, used in wound suturing that are used for operating on different wounds.
Square Knot; one hand technique: the two hand technique is often used to tie the square knot however on some occasions it’s not the right technique to try, in those moments the one hand square knot technique is tried, either the left hand of the right.
Square Knot; Two Hand Technique: this technique used for closing wounds is the considered the easiest and most reliable when it comes to the usage of most suture materials for tying. The same technique can be used with surgical gut, surgical cotton, virgin silk, and, surgical stainless steel.
Deep tie knot: tying up a suture in a deep body cavity can be difficult, and requires a much more complex type of knot. In order to stay tied up, the square knot must be firmly snuggled down. However the operator must perform the suture in a way that avoids upward tension of the suture or else the delicate tissue might tear.
Instrument tie: this knot tying technique is particularly useful if/when the ends of both the suture material are short. To get the best results on the procedure, it is advised to proceed with caution when using the needle holder, especially when the suture is of a synthetic absorbable type or any other monofilament suture as repeated bending can cause the sutures to break.
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