From the Research
Suturing is generally not recommended for chronic wounds, as it can lead to increased risk of infection and complications, and instead, alternative wound management strategies should be prioritized. The most recent and highest quality study, 1, published in 2019, emphasizes the importance of using the TIME framework (Tissue, Infection, Moisture, Edge) to guide the management of chronic wounds. This framework highlights the need to address underlying causes of wound chronicity, such as tissue non-viability, infection, and moisture imbalance, before considering closure techniques.
When considering suturing for a chronic wound, it is essential to approach with caution and prioritize alternative methods that promote granulation and epithelialization. The study 2 published in 2016, discusses recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers, emphasizing the importance of preventative and treatment measures, including disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies.
If suturing is deemed absolutely necessary by a specialist, the wound should first be thoroughly debrided and any infection treated. A loose, tension-free closure technique with non-absorbable sutures should be used, and consideration should be given to using vertical mattress sutures to reduce tension and improve wound edge eversion. The sutures should be left in place for an extended period, typically 14-21 days, depending on the wound location and healing progress, as suggested by the study 3 published in 2004.
Post-closure care is crucial, and an appropriate dressing should be applied to maintain a moist wound environment and protect the sutures. Close monitoring for signs of infection or wound dehiscence is necessary, and patients should be instructed to avoid putting tension on the wound and to keep the area clean and dry. The study 4 published in 2004, provides a systematic approach to removing barriers to healing, including tissue non-viability, infection, and moisture imbalance, which is essential for effective wound management.
Key considerations for managing chronic wounds include:
- Using alternative wound management strategies, such as regular debridement, moist wound healing, negative pressure wound therapy, or advanced dressings
- Addressing underlying causes of wound chronicity, such as tissue non-viability, infection, and moisture imbalance
- Prioritizing preventative and treatment measures, including disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies
- Approaching suturing with caution and using a loose, tension-free closure technique with non-absorbable sutures, if necessary.