7. Wound closure

Wound closure is a fundamental skill in surgery and one in which plastic and reconstructive surgeons must possess expert proficiency. As mentioned above, the skin provides the aesthetic definition of the body and is also a major contributor to innate immunity, protecting our internal structures from environmental hazards. Maintaining the integrity of the skin is thus crucial for the preservation of health; lack of its maintenance invariably leads to significant morbidity and mortality through infection, heat loss, fluid imbalance and direct damage to internal structures.

The most common method of wound closure is suturing. This practice is believed to date back to ancient Egyptian times, when it was used to treat the living and also to prepare mummies for burial. Other wound closure techniques include staples, skin tape and tissue adhesives. The decision regarding which technique is used depends on the characteristics of the defect being closed and other circumstances that may affect closure of the wound or the health of the patient as a whole. For example, insertion of skin staples is faster than suturing and is associated with a lower risk of infection and tissue reaction. It is therefore often preferable when closing wounds to the trunk or lower limbs at the end of a long operation. Whichever technique is used to close a specific wound, the accurate approximation of skin edges without tension leads to minimal scarring. Subdermal wounds are closed in layers with careful suturing to produce a strong and secure closure. The aims of such closure are to eliminate dead space and to provide enough strength to enable wound healing while preventing dehiscence. The strength of closure required varies depending on the function of the particular body area being closed. For example, as the scalp is not particularly mobile or regularly subjected to tension, it does not require as secure a closure as the lower limb. To achieve the additional strength in the latter situation, one might decide to close the individual layers separately, whereas this may not be necessary for closing other types of wounds.