Wound Closure Technique

Wound Irrigation

Debridement Tools

Clamps

Suturing and Closure

Dressings

Tape or Bandages

Adhesives

Patient Preparation:

Inform the patient about surgery risks, benefits, recovery, pain management, restrictions, and physical therapy.

Ensure understanding before obtaining written informed consent.

A mixture of one part sodium bicarbonate and ten parts local anesthesia with epinephrine can reduce burning during lidocaine infiltration.

Patient Positioning:

Position patient for best wound access and visibility.

Figure 1. Wound suture

Figure 2. Wound dressing

Closure by secondary intention effectively addresses wounds on concave head and neck areas particularly those at infection risk.

Results are aesthetic and functional to avoid complex flap or skin graft procedures.

The final scar is less visible in older, lighter-skinned patients, and suitable with other techniques.

Deep sutures eliminate dead space, relieve tension, ensure wound edge alignment, and contribute to final eversion of the wound.

For head and neck wound closure, use 5-0 or 6-0 nonabsorbable Prolene, nylon, or absorbable catgut sutures carefully.

Eversion of skin edges prevents scar depression and place simple suture knots away from wound edges.

Running Locking Suture: Continuous suture with loops locked for added strength.

Vertical Mattress Sutures: It provides strong eversion of edges to prevent depressed scars.

Horizontal Mattress Sutures: It distributes tension over a wider area.

Approximate wound edges to initiate healing, avoid tight sutures that compromise blood flow to cause tissue necrosis, scarring, and unsatisfactory cosmetic outcomes.

Sutures tied tightly today will become tighter tomorrow. Despite careful tissue handling to cause swelling and increased tension at the suture site.

Subcuticular suture procedure:

Sutures can be intradermal either simple or running with the needle placed horizontally in the dermis without skin penetration.

The buried knot in a simple suture minimizes wound tension, while continuous subcuticular stitches allow suture ends to be taped without knots.

Complications:

Wound dehiscence

Chronic wound formation

Hematoma and seroma formation

Suture-related issues

Necrosis

Scarring