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Primary Surgery Vol.2 – Trauma |  |
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Primary Surgery Vol.2 – Trauma | |
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If the closure of a wound is delayed beyond 10 days, granulation tissue will grow over it. You will have to close it by secondary suture, rather than by delayed primary suture, although there is no sharp dividing line between these two methods. By now its edges will be indurated and and will be less easy to bring together, so you are more likely to have to graft it. It will also have a growing epithelial edge with an inadequate blood supply. You will need to excise this ingrowing edge, and you may have to prepare the granulations before you can graft them (57.3).
A wound is probably ready for secondary suture when its granulations are favourable by the criteria in Section 57.3. If they are unsuitable, prepare them by the methods in that section.
Apply a tourniquet, where posible. Excise the new epithelium at the edge of the wound, undercut its edges, and gently scrape the granulation tissue off the surface of the wound. Release the tourniquet, and control bleeding.
If you can bring the edges together without too much tension, suture them with a few interrupted sutures. Make sure the sutures go underneath the granulation tissue, not through it.
If you cannot bring the skin edges together, graft the bare area. If sepsis is not completely controlled, be sure to mesh the graft. This is the most usual situation.
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Primary Surgery Vol.2 – Trauma | |
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