Professional Documents
Culture Documents
• Goals
• To re-establish functional soft tissue structural
support
• To give the most natural aesthetic appearance
with minimal distortion
Principles of Wound Incision
• First priority - maintain a sterile and aseptic technique to prevent
infection.
• Fusiform excision
Performed with longitudinal axis running
parallel to RSTL
The length should be 4 times with the
width of the defect to produce an
accurate coaptation of skin edges without
dog ear formation.
Principles of Wound Incision
• Dog ears
Areas of redundant skin and subcutaneous tissue
resulting from a wound margin being longer on one
side than the other
Dealt with either by
Incremental oblique placement of sutures to redistribute
the tension across the wound
Fusiform excision of the dog ear with lengthens the scar
considerably
Principles of Wound Incision
Removal of a ‘dog ear’
• Skin defect is sutured until the
“dog ear” becomes apparent
• The “dog ear” is defined with a
skin hook and is incised round
the base
• Excess skin is removed and the
skin is sutured
Principles of Wound Incision
• Tissue handling
Minimum tissue trauma promotes faster healing
Surgeon must handle all tissues very gently - and as little as
possible
Retractors should be placed with care to avoid excessive
pressure, since tension can cause serious complications
Principles of Wound Incision
• Immobilization of wound
Adequate immobilization of the approximated wound, but not
mandatory for the entire anatomic part
For efficient healing and minimal scar formation
Principles of Wound Closure
• Factors influencing surgical wound closure
Local factors
Skill and techniques
Sutures Materials
Tight suturing : Tension
Vascularity necrosis and wound breakdown
Infection/contamination
Systemic factors
Nutrition
Comorbid diseases : Diabetes, rheumatoid arthritis impaired
microcirculation, imunodeficiency HIV
Shock/Oxygenization impairment
Incision: a cut produced surgically
by a sharp instrument that creates an
opening into an organ or space in
the body
Advantages: Disadvantages:
1. Provides access to lateral 1. Longer time to make and close
structures 2. Superior extension may be
limited by costal margin
2. Rectus muscle is not divided
3. May strip muscles from their
3. Can be extended by a lateral blood and nerve supply:
curvilinear incision towards the atrophy of muscle medial to
xyphoid process if required the incision
Charles McBurney