From the Guidelines
The proper procedure for wound closure involves cleaning the wound thoroughly with sterile saline, controlling bleeding, and choosing the appropriate closure method based on wound size, depth, and location, as supported by the most recent evidence from 1 and 1.
Key Steps for Wound Closure
- Clean the wound with sterile saline or mild soap and water to remove debris and bacteria.
- Apply gentle pressure with sterile gauze to control bleeding.
- Choose the appropriate closure method:
- Adhesive strips
- Tissue adhesive (like Dermabond)
- Staples
- Sutures (absorbable for internal layers, non-absorbable for skin)
- Irrigate the wound again with saline before closing.
- Maintain sterile technique throughout the procedure.
- Apply antibiotic ointment and cover with a sterile dressing after closure.
Considerations for Suture Removal
- Sutures typically remain in place for 5-14 days, depending on location.
- Facial sutures are removed earlier (5-7 days).
- Sutures on high-tension areas like joints remain longer (10-14 days).
Importance of Wound Closure
Proper wound closure reduces infection risk, minimizes scarring, restores tissue integrity, and accelerates healing by bringing wound edges together to allow for primary intention healing where new tissue forms directly between approximated edges, as noted in 1 and 1.
Additional Recommendations
- Infected wounds should not be closed, as stated in 1.
- Wounds on the face can be closed primarily if seen by a plastic surgeon, provided there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics, as mentioned in 1.
- The use of negative pressure wound therapy (NPWT) may be beneficial in managing complex wounds, as discussed in 1 and 1.
From the Research
Wound Closure Procedure
The proper procedure for wound closure involves several steps, including:
- Debridement: the removal of necrotic material, scabs, devitalized tissues, and other impurities that delay wound healing 2, 3, 4
- Wound irrigation: to remove foreign matter, hematoma, and decrease contaminants, such as bacteria 4
- Repair of deep structures: to help restore function 4
- Administration of antibiotics and tetanus prophylaxis protocol: as appropriate 4
- Wound closure: which can be primary closure, delayed primary closure, or secondary intention (granulation) 4, 5
Debridement Techniques
There are many debridement techniques approved by the European Wound Management Association, and the selection of the most appropriate method depends on factors such as tissue type, presence of biofilm, depth and location of the wound, and underlying cause 2.
Adjuncts to Wound Closure
Adjunctive treatments, including hyperbaric oxygen, growth factors, skin substitutes, and negative-pressure wound therapy (e.g., V.A.C.), can provide the proper conditions for healing in appropriately selected patients 6.
Delayed Wound Closure
Delayed wound closure should be used in wounds that are contaminated or contain devitalized tissue, and the wound should be left open for three to four days for observation to determine if infection is present or if the tissues are devitalized 5.