Surgical Wound Sutures

Primary and primary delayed suture

Primary closure of a wound defect traditionally serves as the final stage of primary surgical wound debridement (PSWD). In addition, classic aseptic operations conclude in this exact manner.

• Timing: Placement is performed within the first 24 hours after injury.
• Course: The inflammatory response with this approach is minimal. The process proceeds via classic healing by primary intention.

Purulent foci deserve special attention. Approximation of the edges is permitted after the surgeon has opened the abscess or phlegmon and completely excised all necrotic masses. However, this requires strict adherence to the most important condition: adequate conditions for full drainage must be ensured. Additionally, prolonged and continuous irrigation of the cavity with special antiseptic solutions or proteolytic enzyme-based preparations is organized.

If immediate closure carries a high risk, primary delayed tactics are employed.

• Timing: The procedure is performed within 5–7 days after PSWD. The most important landmark is that tissues are approximated strictly before granulations begin to appear.
• Condition: The complete absence of any signs of wound suppuration is strictly required.

An interesting variant of this technique is provisional sutures. Their specificity lies in the fact that the threads are passed through the tissues during the initial operation but are not tied. The knots are tightened only a few days later, after verifying that suppuration has not developed.

Classification of secondary sutures

Secondary edge approximation is used when the time for primary closure has been missed. Depending on the timing and morphological changes in the tissues, two main types are distinguished:

1. Early secondary suture
2. Timing: Applied within the window of 8 to 15 days.
3. Features: The defect is already covered with granulation tissue. At the same time, the edges remain sufficiently mobile and elastic.
4. Technique: Since the tissues have retained their mobility, additional edge excision is not performed. They are simply brought together and securely fixed.

1. Late secondary suture
2. Timing: Applied 2 weeks or more after defect formation.
3. Features: Pronounced scarring changes have already occurred in the walls and edges of the wound. Due to the formation of dense tissue, simple edge approximation becomes impossible.
4. Technique: Before placing the sutures, the surgeon must necessarily perform edge mobilization and complete excision of the scar tissue. Note: if too large a skin defect forms after excision, skin-grafting methods are employed.

Indications for wound closure

Before making a final decision on placing delayed or secondary sutures, the physician must comprehensively assess the patient's general condition and the local picture in the lesion.

General readiness criteria:

• Complete normalization of the patient's body temperature.
• Restoration of a normal blood profile.
• Satisfactory clinical condition of the patient.

Local criteria (on the part of the wound itself):

• Complete disappearance of inflammatory edema and hyperemia in the surrounding tissues.
• Absolute cleansing of the bottom and walls from accumulations of pus and necrotic tissue.
• Presence of healthy granulations. They must be visually bright, lush, and viable.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Stages of primary surgical wound debridement (PSWD)
• Drainage methods and prolonged irrigation of purulent wounds
• Proteolytic enzyme preparations in surgery
• Types of skin plasty in large wound defects
• Morphology of granulation and scar tissue

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.