54.2 Immediate primary suture

This is the suture of a wound within six hours of the injury, but it is only safe if the wound is clean, and if it contains no dead tissue. All other wounds are best packed with gauze and left open to see what happens 3 days later (54.4).

When you suture any wound, aim to: (1) Close it at all points and in all planes. Suture it so as to obliterate dead spaces in which blood and exudate can collect as in B, and C, Fig. 54-5. If you allow them to collect, as in F, and G, in this figure, they may become infected, and when they finally organize they will cause a denser scar. (2) Cause as little trauma as you can by using sharp needles and fine sutures. Avoid heavy toothed forceps, blunt knives, and tissue forceps on the skin edges.

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Figure 54.5: SUTURING A WOUND. A, a vertical mattress suture is an excellent way of making sure that skin edges are inverted. There is a small superficial bite and a large deeper one. B, and C, show a correctly placed suture. The dotted line in B, shows the path of the suture. If ’X’ is smaller than ’Y’, the skin edges will be everted. The suture should enter the skin at 90\ensuremath{^\circ }. D, and E, the edges of the wound have been everted to get a good bite of tissue. F, and G, show how NOT to do it; the suture is too superficial and the skin edges are inverted. From various sources, partly Hamilton Bailey with kind permission of Hugh Dudley.