Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 6. Emergency Wound Management >|
Chapter 45. Methods for Wound Closure
Sections: Methods for Wound Closure: Introduction, Overview of Wound Closure Methods, References.
Topics Discussed: wound closure.
Excerpt:"The major goal of wound closure is to restore the skin's
integrity in order to reduce the risk of infection, scarring, and
impaired function. This may be achieved by one of three methods.
With primary closure, the wound is immediately closed by approximating
its edges. The main advantage of primary closure is a reduction
in healing time in comparison with other closure methods. Rapid
wound closure also may reduce bleeding and discomfort often associated
with open wounds. Secondary wound closure, in which the wound is
left open and allowed to close on its own, is particularly well
suited for highly contaminated or infected wounds as well as in
patients at high risk of infection. Although this method may reduce
the risk of infection, it is relatively slow and uncomfortable and
leaves a larger scar than primary closure. Delayed primary (or tertiary)
closure combines the advantages of both primary and secondary closure.
With this method, the wound is initially cleansed and then packed
with dry sterile gauze followed by a sterile covering. The dressing
is left undisturbed unless signs of infection develop: fever, purulent
exudate, or spreading cellulitis. After 4 to 5 days, the dressing
is removed and the wound edges can be closed if no infection has
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