skin closure

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1.       mass closure, running suture, using #1 PDS with a suture length to
wound length ratio of 4 to 1 (Israelsson LA, Sweden, based his PhD on this,
and it has been confirmed more recently)

2.       absolutely not..not necessary if no tension..if too much tension
leave "open" while aiming at getting the patient out of the oedema phase

3.       close skin (staples or suture)..watch and open a few cm if there is
an infection 

 

Tina Gaarder

Oslo

 

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Sise, Mike MD
Sent: 04 February 2009 14:45
To: Trauma & Critical Care mailing list
Subject: RE: skin closure

 

Regarding abdominal wound management following damage control: please
consider and answer 3 questions in stable patient with non contaminated
abdomen post op 24 to 72 hrs at first take back:

 

1. What kind of fascial closure if it comes together without tension:
running or interrupted and what suture?

2. Any role for retention sutures?

3. Skin closure: when and how - complete closure , place wicks or drains?

 

Mike Sise 

San Diego

 

  _____  

From: Ruy Cabello-Pasini [mailto:ruycabello at yahoo.com]
Sent: Tue 2/3/2009 8:42 PM
To: Trauma & Critical Care mailing list
Subject: Re: skin closure

I also always close the skin, if patient has a thick subcutaneous layer, I
use a penrose drain over the aponeurosis and through the same incision,
anybody?
Ruy Cabello-Pasini, MD
MEXICO 


--- On Wed, 2/4/09, Robert Nitt <robertnitt at yahoo.com> wrote:

> From: Robert Nitt <robertnitt at yahoo.com>
> Subject: Re: trauma-list Digest, Vol 67, Issue 43
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Date: Wednesday, February 4, 2009, 3:35 AM
> Close skin whenever can.  If damage control with extensive
> resuscitation or bowel spillage, pack open and delayed
> closure
>
>  Kumash Patel, MD, FACS
> Scottsdale Surgical Specialists
> General / Acute Care / Trauma / Critical Care Surgery
>
>
>
>
> ________________________________
> From: "McSwain, Norman E Jr."
> <nmcswai at tulane.edu>
> To: trauma-list at trauma.org
> Sent: Tuesday, February 3, 2009 5:39:42 AM
> Subject: Re: trauma-list Digest, Vol 67, Issue 43
>
> This "older surgeon" would likely close the skin.
>
> Preferences & principles again...
>
> principle: skin needs to closed sometime.
>
> Preference - when?.........What is the condition of the
> wound. It is less than 72 hours; no bowel injury; was the
> patient overloaded with fluid?; how much pull on the skin to
> close?.
>
>
> Typed by the thumbs of
> Norman on his BlackBerry
>
> Norman McSwain, MD
> Tulane Univ Surgery
> 504 988-5111
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org
> To: trauma-list at trauma.org
> Sent: Mon Feb 02 22:39:54 2009
> Subject: RE: trauma-list Digest, Vol 67, Issue 43
>
>
> To all trauma-listers, a question from one of my partners:
>
>
> You have a damage control closure with a vac closure after
> a laparotomy for trauma without bowel injury (ie just spleen
> or liver, mesentery, whatever) - you take back in 24 to 48
> hours and are able to close the fascia.  What do you do with
> the skin?  Leave open or staple closed? 
>
> We're having a debate over this in our group. Older
> surgeons pack skin and subQ open, younger surgeons
> frequently close skin.
>
> Mike Sise
> San Diego
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of
> trauma-list-request at trauma.org
> Sent: Tue 1/27/2009 12:35 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 67, Issue 43
>
>
>
> Send trauma-list mailing list submissions to
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