1. CLASSIFICATION OF WOUNDS

2. clean wounds uninfected operative wound in which no inflammation is encountered and respiratory, alimentary, genital, or uninfected urinary tracts are not entered.

3. clean wounds closed by primary union and usually are not drained.

4. Clean-contaminated wounds respiratory, alimentary, genital, or respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination urinary tracts are entered under controlled conditions and without unusual contamination Appendectomies, cholecystectomies, and hysterectomies entry into a viscus resulting in minimal spillage of contents.

5. contaminated wounds open, traumatic wounds or injuries such as soft tissue lacerations, open fractures, and penetrating wounds; operative procedures in which gross spillage from the gastrointestinal tract occurs; genitourinary or biliary tract procedures in the presence of infected urine or bile open, traumatic wounds or injuries such as soft tissue lacerations, open fractures, and penetrating wounds; operative procedures in which gross spillage from the gastrointestinal tract occurs; genitourinary or biliary tract procedures in the presence of infected urine or bile

6. Dirty and infected wounds Perforated viscera, abscesses, or neglected traumatic wounds in which devitalized tissue or foreign material have been retained. Perforated viscera, abscesses, or neglected traumatic wounds in which devitalized tissue or foreign material have been retained.

7. HEALING BY PRIMARY INTENTION minimum of time, with no separation of the minimum of time, with no separation of the wound edges, and with minimal scar formation. wound edges, and with minimal scar formation.

8. HEALING BY SECOND INTENTION infection, excessive trauma, tissue loss, or imprecise approximation of tissue. infection, excessive trauma, tissue loss, or imprecise approximation of tissue. wound may be left open and allowed to heal from the inner layer to the outer surface.

9. Granulation tissue forms and contains myofibroblasts. Granulation tissue forms and contains myofibroblasts. help to close the wound by contraction. help to close the wound by contraction. granulation tissue may build up and prevent epithelialization.

10. DELAYED PRIMARY CLOSURE contaminated, as well as dirty and infected traumatic wounds with extensive tissue loss and a high risk of infection. contaminated, as well as dirty and infected traumatic wounds with extensive tissue loss and a high risk of infection.

11. Wound approximation can occur within 3-5 days if the wound demonstrates no evidence of infection

13. suture

14. SUTURE CHARACTERISTICS SIZE - smallest diameter suture that will adequately hold the mending wounded tissue. number of 0s in the suture size increases, the diameter of the strand decreases.

15. TENSILE STRENGTH force, in pounds, which the suture strand can withstand before it breaks when knotted. force, in pounds, which the suture strand can withstand before it breaks when knotted.

16. MONOFILAMENT VS. MULTIFILAMENT STRANDS Monofilament single strand of material. single strand of material. less resistance as they pass through tissue less resistance as they pass through tissue They also resist harboring organisms which may cause infection. They also resist harboring organisms which may cause infection. well-suited to vascular surgery. well-suited to vascular surgery.

17. Multifilament sutures several filaments, or strands, twisted or braided together. several filaments, or strands, twisted or braided together. greater tensile strength and flexibility. greater tensile strength and flexibility.

18. ABSORBABLE VS. NONABSORBABLE SUTURES rapid degradation losing their tensile strength within 60 days -absorbable sutures. longer than 60 days - nonabsorbable suture

19. Nonabsorbable sutures Exterior skin closure, to be removed after sufficient healing has occurred. Exterior skin closure, to be removed after sufficient healing has occurred. Within the body cavity, where they will remain permanently encapsulated in tissue. Within the body cavity, where they will remain permanently encapsulated in tissue. Patient history of reaction to absorbable sutures, keloidal Patient history of reaction to absorbable sutures, keloidal tendency, or possible tissue hypertrophy. tendency, or possible tissue hypertrophy. Prosthesis attachment defibrillators, pacemakers Prosthesis attachment defibrillators, pacemakers

24. Square Knot

25. One-Handed Technique

26. Surgeon's or Friction Knot

27. CONTINUOUS SUTURES can be placed rapidly. can be placed rapidly. It derives its strength from tension distribut evenly along the full length of the suture strand It derives its strength from tension distribut evenly along the full length of the suture strand