Problem Wounds

Several factors should be considered in choosing the best approach for wound closure. For example, deep wounds produce potential spaces, which, when the overlying skin is closed, can be susceptible to infection. Closure of deep space is controversial, as absorbable sutures placed to close this potential space increase the risk of infection due to the presence of the suture foreign body. Parallel lacerations may have compromised perfusion to the "island" of skin between the lacerations that could be further impaired by percutaneous sutures. To minimize damage to subcutaneous blood vessels and reduce skin tension on the intervening strips of skin, horizontal mattress sutures or closure with skin-closure tapes or tissue adhesives alone should be considered ( Fig 37125).

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