Gentle tissue handling: Use fine-toothed forceps such as Adson forceps; do not use smooth forceps, since these crush tissue because they require greater pressure to grasp. Avoid using “rat-toothed” forceps on skin.
Hemostasis: Maintain hemostasis as blood can act as a culture medium.
Limit bacterial influences on the wound: Reduce bacterial contamination through irrigation of wounds when necessary and appropriate. Use a 50-cc syringe with a 16 or 18-gauge needle. Sterile saline or Lactated Ringer’s Solution can be sterilely aspirated, and a pulsatile irrigating stream can be created by depressing the plunger with force. Avoid antiseptic solutions as often times these chemicals only slow the phases of healing.
Debridement: Gently remove all sources of devitalized tissue and any foreign material through lavage or surgical removal with a scalpel blade or Metzenbaum scissors.
Approximate; don’t strangulate. The wound edges should be accurately apposed. Avoid eversion or inversion of wound edges. Sutures that are too tight can cause ischemia of the wound edges, increasing the risk of infection and necrosis. Tight sutures also can cause excess scarring. Consider the holding layers of the tissue planes you are closing. For example, when closing body wall, only suture the external rectus sheath, avoiding the muscle layers. The muscle provides no holding power and when included in your suture pattern, will increased patient morbidity.
Gentle tissue handling!
Did I mention this already? Yes, because it is that important! The goal of wound closure should be to achieve healing as quickly as possible with:
- No bacterial contamination or infection
- Quick return to Normal function
- Excellent cosmetic results
These goals are greatly facilitated by handling tissues gently.
Stay tuned for future blog posts as I get into suture and needle basics.
Jacob M Shivley, DVM