Incisions & Closures
Purpose of incision
- Access
- Optimise healing
- Good cosmesis
Additional considerations:
- Neurovascular structures below incision line which may be injured
- Previous wounds which may impede blood supply to wound (parallel linear wounds render separated tissue inschaemic)
- Relaxed skin tension lines
- Avoid multiple cuts into fat (risk of fat necrosis)
Specific Incisions
- Transverse: (1) muscle cutting (2) muscle splitting
- Midline: "incision of indecision" rapid access, minimal blood loss, easy closure
- Kochers
- McBurney/gridiron
- Lanz
- Rooftop
- Paramedian: take longer to form, close, higher risk of blood loss, low complication rate
- Suprainguinal (Rutherford-Morrison)
- Inguinal
- Pfannenstiel
Principles of wound closure
- Edges should be in good apposition (with slight gaping to allow for swelling)
- Wound edges should be everted
- Minimal suture material should be used to secure wound
- Knots should be secure, to one side of wound and easy to remove
Closure options
- Heal by primary intention
- Heal by secondary intention +/- VAC, large surface area wounds, large cavitating wounds
- Delayed primary closure
- Steri-strips
- Tissue glue
- Skin staples
- Sutures
- Subcuticular - good cosmesis, suitable for clean linear wounds
- Simple interrupted
- Vertical mattress
- Horizontal mattress
