Post-excisional Wound Closure Chapter for Rural Surgeons

Abstract

Repair of any skin defect is determined primarily by the size of the defect and the laxity of the surrounding skin. Approximating the edges of any defect with reasonable tension depends on the mobility of the neighboring tissue, which varies according to the location. For instance, closing an abdominal defect primarily is easier than closing a sternal defect or one over the shoulder area. Similarly, as a general rule, the more distal an extremity wound is, the more challenging the reconstruction becomes. The first step in any reconstructive procedure is to define the defect fully. While the dimensions of the defect are important, one must also consider the quality of the skin and subcutaneous tissue, the type of tissue at the base of the wound and the surrounding structures. Many wounds can be closed primarily provided that sufficient undermining is performed to allow for minimum tension on the skin edges. Other wounds may require tissue recruitment from the surrounding skin in the form of rotation or advancement flaps, or skin grafting from distant donor sites.