Page 15 - Manual of Equine Field Surgery
P. 15
CHAPTER 3
Wound Closure
David A. Wilson
The principles of wound closure are similar WOUND PREPARATION
whether closing a surgical incision or a laceration.
Primary closure relies on a clean field) with clean The objective in wound preparation is to reduce
and viable wound margins and skin edges for the contamination of a wound and to obtain a
closure. When presented with a naturally occur- "clean" field. Infection is the most importa11t
ring wound, there are many factors to consider, factor in delaying wound healing. Infections are
but the primary objectives are to preserve the life classified as primary, in which the contamination
of the patient, to determine the extent of the occurs at the time of injury, or secondary, in
wound, and to prevent or minimize infection. which the contamination occurs through the
A minor wound should not divert attention suture line or through other portals (i.e., drains,
from more serious problems, such as hemorrhagic fistulas) .
shock, exhaustion, or cerebral contusion associ- Before wound preparation, the wound should
ated with head injuries. Thus, a quick assessment be protected by placing sterile, water-soluble
of the wo1111d should be followed by a thorough lubricating jelly or sterile moist gauze sponges
physical examination and acquisition of pertinent i11to the wound. A wide area of hair around the
vital signs. After initial stabilization and control of wound should be clipped. To prevent hair from
bleeding, attention should be directed at deter- falling into the wound, the hair may be dampened
mining the extent of the wound and returning the with water or lightly coated with a sterile, water-
patient to a normal functional and cosmetic status soluble lubricating jelly. Sponges used to pack the
with the shortest delay possible. wound should be discarded and replaced by new
Wounds should be thoroughly evaluated to 011es after each stage of preparation. The wound
determine their extent. Wounds over synovial bed itself should be gently cleansed with antisep-
structures such as joints or tendon sheaths are tic soap and sterile gat1ze sponges, followed by
common in horses, and the involvement of these copious lavage to neutralize the detergent base
structures is often unrecognized. Tendons and lig- of the antiseptic. The clipped area should be
aments, vessels and nerves, and the eyes, sinuses, scrubbed at least three times with antiseptic soap
thorax, and abdomen are other structures com- and rinsed between scrubs with sterile 0.9o/o saline
monly involved i11 equine wounds. Thinking in solution.
three dimensions and understanding the three-
dimensional anatomy of the involved structures
will help the practitioner to recognize the poten- Antiseptics for Skin Preparation
tial extent of the injuries and to better prepare the
owner for the potential problems associated with The two most commonly used surgical scrubs
the WOL1nd. for skin preparation are povidone-iodine and
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