Essential Steps In Primary Wound Closure

  • Hadiza Bello Doctor of Medicine - MD, All Saints University, Saint Vincent, UK

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Introduction 

Wounds are a common occurrence, ranging from accidental injuries during daily activities to intentional incisions from surgical procedures. Healthcare professionals and patients alike need to understand the principles and techniques of primary wound closure. This article delves into the intricacies of primary wound closure, its importance, methods, and the considerations that guide healthcare providers in achieving successful wound healing.

Aims of wound closure

Most wounds we get from normal daily activities are often minor and will heal without any intervention. However, some wounds are more complex, being bigger, deeper, in unusual areas of the body, or caused by objects that may carry certain organisms harmful to the human body. Most wounds that need to be closed for reasons including:

  • To shorten healing time
  • To reduce or stop bleeding
  • To decrease the risk of infection
  • To reduce pain
  • To minimize infection risk

What is primary wound closure?

Primary wound closure is usually when the edges of a wound are brought together and held by sutures, adhesives, staples, or glues. This is done to keep the openings of the wound together while the body heals itself. Primary wound closure is often done as soon as possible after an injury.

Wound closure techniques1

Sutures: Also called stitches, this is the most common technique of primary wound closure.1 This technique uses a needle and a length of thread to align the edges of a wound and hold it together. There are different types of sutures, some of which do not have to be removed as they get absorbed by the body, and others that have to be removed when the wound has healed. 

Staples: These work in the same way as regular staples used on paper. They are used to hold together the edges of a wound while it heals. Staples always have to be removed.

Adhesives:  These are medical-grade glues that are applied to the wound edges to hold them together. These, too, eventually get absorbed and do not need to be removed. They are often used for wounds on the face or small wounds on children

Procedures, materials and tools used for wound closure

What to expect before your wound is closed:

The technique your healthcare provider uses depends on a lot of factors, like the size and depth of your wound, its location, and other individual factors. Surgical wounds are most often closed using sutures or staples, while shallower wounds sustained in day-to-day activities may be closed 

with adhesive strips.

Materials and tools: 

All tools and materials used in wound closure are sterile to avoid introducing harmful organisms that may cause infection into the wound. Some  equipment used in wound-closing procedures include:

  • Special strips, sutures, staples, or glue
  • Scissors 
  • Numbing medication (to help decrease pain during the procedure)
  • Antiseptics (to disinfect the wound and the skin around it)
  • Sterile gauze and bandages

Inspection: 

The first thing your healthcare professional will do is assess your wound. If there is any bleeding, they will attempt to get it under control. After taking your medical history and how the wound was sustained, inspect your wound to check how deep it is, if there are any foreign materials in it like dirt or signs of infection like redness and swelling.  

Pain management:1

Wounds are usually accompanied by pain, and your healthcare provider will ensure that you are comfortable and aim to minimize pain during the procedure. Pain management can be achieved in several different ways, such as local anaesthesic, which is used to numb the area around the wound. For example, lidocaine is a common local anesthetic. You might also be given oral analgesics and the local numbing agents that may be used before the procedure.

Cleaning the wound:1

Some wounds, especially non-surgical ones, may have dirt that needs cleaning to prevent infection. This is commonly done with a sterile saline solution to remove any debris in the wound. Antiseptics like povidone-iodine or hydrogen peroxide may be used to clean the wound in cases where the wound is particularly dirty or was sustained from objects that are likely to transfer infection.

Bringing the edges of the wound together:

Once a method for wound closure has been decided and your wound is properly cleaned, it is time to close it.

Suturing technique:1

The suturing process is done by passing the needle through one side of the wound, starting at one edge of the wound. It is then gently pulled, leaving a tail to tie knots later. The needle is then passed through the opposite side of the wound. This process is repeated until the wound is closed and a knot is tied at the tail. Several different types of sutures can be done.

Stapling technique:1

For this technique, the wound edges are aligned, and then a skin stapler is placed over the wound. The stapler is gently squeezed, discharging a staple pin that holds the edges of the wound together. This is repeated throughout the length of the wound, evenly spacing the staples. 

Adhesive closure:1

An adhesive agent such as cyanoacrylate is used for this wound closure technique. A small amount is spread on the wound edges, which are pressed together and held in place until the adhesive sets.

How to care for your wound after closure: 

A newly closed wound is fragile and should be cared for properly by keeping it clean and covered. Healthcare providers will cover your wound with materials that protect it from the environment. And will advise you when to come back to take off the materials used to close the wound, depending on what was used. You will also be counseled on how to spot signs of infection. Sometimes antibiotics could be prescribed to help prevent infection.

Special situations 

Closing wounds on different parts of the body:

Wounds on the Face:

Facial wounds often require special attention due to their and the presence of delicate tissues like the eyes. Adhesives are often preferred for small wounds on the face and it should be noted that there ispotential for impact upon appearance.

Closing wounds for different people:

Kids with wounds:

Wound closure in children requires a different approach due to their level of activity and limited understanding of the situation. Children’s wounds are also often closed with materials that do not need future removals, like absorbable sutures or adhesives,2 as removal might be distressing for them.

Elderly individuals:

Elderly individuals often have more fragile skin and may have slower wound healing than younger people.3 Older adults are also more likely to have chronic conditions like diabetes or vascular issues that may interfere with wound healing. Older individuals may also have different pain management needs, which must be taken into consideration and adjusted as needed.

Summary 

Wounds can result from everyday accidents or intentionally created by surgical procedures. Primary wound closure is an intervention in a wound to help it heal better. This intervention is done to reduce or stop bleeding, shorten healing time, minimise the risk of infection, and, in some cases, restore the function of the affected area. There are a lot of different techniques of primary wound closure, which all depend on the severity of the wound, the type of wound, and sometimes the individual who sustained the wound. Common techniques for primary wound closure are sutures, adhesives and staples. Wound closure is very personalised and differs according to the location of the wound, the size and depth of the wound, the age of the patient, and any other conditions they may have that could affect healing.

References

  1. Azmat CE, Council M. Wound closure techniques. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Sep 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470598/
  2. Mattick A. Use of tissue adhesives in the management of paediatric lacerations. Emergency Medicine Journal [Internet]. 2002 Sep 1 [cited 2023 Sep 8];19(5):382–5. Available from: https://emj.bmj.com/content/19/5/382
  3. Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, et al. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen [Internet]. 2015 Jan [cited 2023 Sep 8];23(1):1–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414710/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hadiza Bello

Doctor of Medicine - MD, All Saints University, Saint Vincent

Hadiza is a Medical Doctor who has worked in a clinical setting for five years, gaining valuable experience in diagnosing and treating a wide range of conditions.
She is currently pursuing an MSc in Infectious Diseases at the University of Kent
She is constantly exploring options to get involved in global health initiatives and is passionate about making healthcare more accessible and equitable for all.

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