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GASTRO/GENSURG

WOUND CLOSURE

Prompt
ResponseWound dehiscence
Midline/paramedian laparotomy wound
Self-rate:
PromptFactors contributing to poor wound healing
ResponsePatient factors
Age >65
Infection
diabetes/anaemia/malnutrition
Obestity
Steroid use
Increased abdominal pressure - coguing/vomiting
Emergency laparotomy
Perforated viscous

Surgical
Too much wound tension or loose knot
Inappropriate knot/technique
Inappropriate suture material
Haematoma at surgical siget
Foreign body
Self-rate:
PromptInvestigations in wound dehiscence
ResponseFBC, CRP, wound swab, cultures, BSL/HbA1c
Self-rate:
PromptPros/cons of different wound closure techniques
ResponseSteristrips
  • Pro: quick/easy to apply, simple wound needing approximation, allow drainage
  • Con: Risk of wound dehiscence, Can’t apply if tension/movement. Keep dry 72h
Tissue Adhesive
  • Pro: Cosmesis = sutures, Infection rate = Sutures, quick
  • Cons: risk of wound dehiscence, avoid on deep/irregular/tensioned wound
Sutures
  • Good approximation, less dehiscence
  • Cons: Time consuming, local anesthetic required, needs removal
Staples:
  • Pro: Speed
  • Con: cosmesis
Self-rate:
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