Surgical Wound Closure Techniques

Why Surgical Wound Closure Techniques?

The healing of cutaneous wounds after surgery is the result of a cascade of complex biochemical events that can be categorized into four overlapping phases: haemostasis, inflammation, proliferation, and remodelling. All these phases of wound healing are influenced by both intrinsic and extrinsic (inside and outside) mechanical forces which effect the tension in the skin. Evidence shows that extracellular matrix remodelling can be upset by these forces. For example, wounds over or near joints may be more likely to develop hypertrophic scars because of joint movements causing repeated tension on the wound, leading to abnormal scarring.

Suture techniques to minimize dermal tension

Dermal sutures alone do not effectively reduce tension on the dermis; deeper structures such as the superficial and deep fascia also need suturing. A study showed that deep fascia suturing reduced about 90% of tension on the wound edge, while superficial fascia suturing reduced the remaining 10% of the tension.

Z-Plasty

Another way to prevent pathological scar formation in high-tension areas is to use zigzag suturing techniques such as the Z-plasty. Z-plasty is particularly suitable for joint or limb surgery because the fatty tissue layer in these areas is thin: this means that it is difficult to find the superficial fascia and apply the subcutaneous/ fascial tensile reduction sutures.

Closeup photo of stitching up wound on the cheek with needle
Photo of stitching up of a wound on the hand with needle
Photo of stitching up of a wound during surgery with needle
Photo of sutures on the nose of a man
Photo of hand surgery using a Z-plasty technique
Photo of sutures on a hand on the operation table right after surgery

Used for

Horizontal keloid | Linear scar | Pliability | Redness | Small keloid | Vertical keloid

F.A.Q.

How can I ensure good scar healing after wound closure?

To promote optimal scar healing after wound closure, it is important to follow the instructions provided by your surgeon or healthcare provider. This includes carefully caring for the wound according to the given guidelines, such as keeping it clean and protected. Avoiding excessive tension on the wound is also crucial, especially in areas near joints, where repeated movement can put stress on the wound and affect scarring. If needed, deeper tissues like the fascia may be sutured to reduce tension on the wound edges. Additionally, maintaining a healthy lifestyle, including a balanced diet and avoiding smoking, is important, as smoking can delay wound healing.

How long does it take for a wound to close and for a scar to form?

The time required for a wound to fully close and for a scar to form can vary depending on several factors, including the size and depth of the wound, the individual's overall health, and the wound closure technique used. Generally, a wound may close within a few days to weeks, but the scar formation process can take months to even a year for the scar to fully mature and achieve its final appearance.

What are the potential risks and side effects of wound closure for scars?

Although wound closure techniques are essential for proper wound healing, there are some associated risks and side effects. These include infection of the wound, allergic reactions to materials used, delayed wound healing, excessive scar formation such as keloids or hypertrophic scars, and discomfort or pain during the healing process. It is important to discuss these potential complications with your surgeon or healthcare provider and report any concerns promptly for appropriate treatment.