INCISION CARE SURGICAL SUTURES
Category: Plastic Surgery
Abstract : Incision care Definition Incision care refers to a series of procedures and precautions related to closing a wound or surgical incision; protecting the cut or injured tissues from contamination or infection; and caring properly for the new skin that forms during the healing process. Incision care begins in the hospital or outpatient clinic and is continued by the patient during recovery at
Incision care
Definition
Incision care refers to a series of procedures and precautions related to closing a wound or surgical incision; protecting the cut or injured tissues from contamination or infection; and caring properly for the new skin that forms during the healing process. Incision care begins in the hospital or outpatient clinic and is continued by the patient during recovery at home.
Purpose
There are several reasons for caring properly for an incision or wound. These include:
• lowering the risk of postoperative complications, particularly infection
• avoiding unnecessary pain or discomfort
• minimizing scarring
• preventing blood loss
Description
Types of wound or incision closure Proper care of an incision begins with knowing what material or technique the surgeon used to close the cut.
There are four major types of closure used in Canada and the United States as of 2003.
SURGICAL SUTURES
Sutures, or stitches, are the oldest method still in use to close an incision. The surgeon uses a sterilized thread, which may be made of natural materials (silk or catgut) or synthetic fibers, to stitch the edges of the cut together with a special curved needle. There are two major types of sutures, absorbable and nonabsorbable. Absorbable sutures are gradually broken down in the body, usually within two months. Absorbable sutures do not have to be removed. They are used most commonly to close the deeper layers of tissue in a large incision or in such areas as the mouth.
Nonabsorbable sutures are not broken down in the body and must be removed after the incision has healed. They are used most often to close the outer layers of skin or superficial cuts. Sutures have several disadvantages. Because they are made of materials that are foreign to the body, they must be carefully sterilized and the skin around the incision cleansed with Betadine or a similar antiseptic to minimize the risk of infection. Suturing also requires more time than newer methods of closure. If the patient is not under general anesthesia, the surgeon must first apply or inject a local anesthetic before suturing. Lastly, there is a higher risk of scarring with sutures, particularly if the surgeon puts too much tension on the thread while stitching or selects thread that is too thick for the specific procedure.
SURGICAL STAPLES
Surgical staples are a newer method of incision closure. Staples are typically made of stainless steel or titanium. They are used most commonly to close lacerations on the scalp or to close the outer layers of skin in orthopedic procedures. They cannot be used on the face, hand, or other areas of the body where tendons and nerves lie close to the surface. Staples are usually removed seven to 10 days after surgery. Staples are less likely to cause infections than sutures, and they also take less time to use. They can, however, leave noticeable scars if the edges of the wound or incision have not been properly aligned. In addition, staples require a special instrument for removal.
STERI-STRIPS
Steri-strips are pieces of adhesive material that can be used in some surgical procedures to help the edges of an incision grow together. They have several advantages, including low rates of infection, speed of application, no need for local anesthesia, and no need for special removal. Steri-strips begin to curl and peel away from the body, usually within five to seven days after surgery. They should be pulled off after two weeks if they have not already fallen off. Steri-strips, however, have two disadvantages: they are not as precise as sutures in bringing the edges of an incision into alignment; and they cannot be used on areas of the body that are hairy or that secrete moisture, such as the palms of the hands or the armpits.
LIQUID TISSUE GLUES
Tissue glues are the newest type of incision closure. They are applied to the edges of the incision and form a bond that holds the tissues together until new tissue is formed. The tissue glues most commonly used as of 2003 belong to a group of chemicals known as cyanoacrylates. In addition to speed of use and a low infection rate, tissue glues are gradually absorbed by the body. They are less likely to cause scarring, which makes them a good choice for facial surgery and other cosmetic procedures. They are also often used to close lacerations or incisions in children, who find them less frightening or painful than sutures or staples. Like Steri-strips, however, tissue glues cannot be used on areas of high moisture. They are also ineffective for use on the knee or elbow joints.
Dressings and drainage devices
After the incision is closed, it is covered with a dressing of some sort to keep it dry and clean, and prevent infection. Most dressings consist of gauze pads held in place by strips of adhesive tape or ACE bandages. An antibiotic ointment may also be applied to the gauze.
A newer type of dressing, called OpSite, is a thin transparent membrane made of polyurethane coated with adhesive. It keeps disease organisms out of the wound while holding a layer of moisture close to the skin. This moist environment keeps scabs from forming and speeds up healing of the incision. OpSite can also be used to hold catheters or drainage tubes in place. It cannot, however, be used for severe (third-degree) burns or deep incisions. Some surgical procedures, such as a mastectomy or removal of a ruptured appendix, require the surgeon to insert a drainage device to remove blood, pus, or other tissue fluids from the area of the incision. It is important to prevent these fluids from collecting under the incision because they encourage the growth of disease organisms. The drain may be left in place after the patient leaves the hospital. If so, the patient will need to check and empty the drain daily in addition to general incision care.
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