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Wound Healing Suture & Needles. John P. Hunt LSU New Orleans Department of Surgery. Objectives. Understand basic science of wound healing Relate this to clinical wound care Learn different types of suture & there applications
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Wound HealingSuture & Needles John P. Hunt LSU New Orleans Department of Surgery
Objectives • Understand basic science of wound healing • Relate this to clinical wound care • Learn different types of suture & there applications • Understand the different types of needles available and there uses
The cells that are central to wound healing are: A) Fibroblasts B) Macrophages C) Polymorphic Neutrophils D) T-cells E) B-cells American Board of Surgery In-training Exam - 2012
Ans – B PMN’s arrive at the site of injury in 24-48 hours, but are gone with another 24 to 48 hours. There primary function involves phagocytosis and release of superoxides. Macrophages peak in the wound at approximately three days post-injury. They have numerous tasks which include phagocytosis, oxidative species production, wound debridement, elaboration of growth factors to stimulate fibroblast production of extracellular matrix materials and production of enzymes to destroy injured cellular matrix components (collagenase and elastase), and elaboration of growth factors to stimulate angiogenesis. Fibroblasts occur in the lag phase of wound healing and typically arrive 3-5 days post-injury and are responsible for collagen formation. T-cells peak at the 5th day and do receive antigen from macrophages. B-cells have little to do with wound healing and may even exhibit an inhibitory effect.
The most common collagen found in skin and bone is: A) Type I B) Type II C) Type III D) Type IV E) Type VI
Ans – A The most common collagen found in adults is type I comprising 80% of all collagen found in skin and bone. The majority of the remaining 20% is type III. There are higher concentrations of type III collagen in children and early wound healing. Type II collagen is found predominantly in articular surfaces. Type IV collagen is found in basal lamina.
Phases of Wound Healing • Wound strength is directly proportional to Type I collagen content • Maximum strength is 80% of original and does not occur for 1-2 years
Layers of Bowel • Mucosa- epithelial cells lamina propria muscularis mucosa • Submucosa- Collagen • Muscularis propria- smooth muscle • Serosa- mesothelium connective tissue
Intestinal Anastomoses • Strength-Submucosa • Collagenase Versus Collagen Deposition • Weakest at 3-7 days
Wound Healing Times Days
Wound Healing Impediments • Tension • Blood supply • Infection • Hypovolemia/Shock • Immunodeficiency • Blood Transfusion • Malnutrition • Medication
Suture Types Absorbable versus Non-absorbable Monofilament versus Braided Synthetic versus Natural
Suture Strength #5 = 5 #4 = 4 #3 = 3 #2 = 2 #1 = 1 0 = 0 2-0 = 00 3-0 = 000 4-0 = 0000 5-0 = 00000 6-0 = 000000 Etc.
Suture Strength 6-0 5-0 4-0 3-0 2-0 0 #1 #2
Suture Strength • Vicryl • 75% of strength at 2 weeks • 50% of strength at 3 weeks
The Point Tapered needles Cutting needles Blunt needles Combination
