'Purse string' suture - reduce wound size and speed up healing 4K

Описание: Disclaimer:
This information is intended to supplement proper clinical training or hands-on surgical course.

A level of basic medical and surgical training is assumed

Info:
The 'Purse string' suture goes around the circumference of a round surgical wound, either buried dermally or through the skin surface. Absorbable or non-absorbable sutures can be used. Its purpose is to partially (or sometimes completely) close a wound, when you cannot close directly (i.e. linear ellipse) and cannot, or do not want to, use a skin graft. Sometimes it is used to reduce the size of a wound in addition to using a (smaller) full thickness skin graft.

Its purpose is usually to make the wound smaller, with the aim of reducing the healing time and dressed area for secondary intention healing. It is quite quick to execute, especially when compared to a local flap or skin graft. However it will usually not heal nearly as quickly as those more complex
closures, so bear in mind the impact on the patient, family and nursing aftercare (not just surgeon time).

It recruits tissue movement from all around, and as such is sometimes an alternative to a rotation flap (which is more complex and time-consuming to design and execute, and may not always be possible in any case).

It is often used for secondary intention healing on the scalp (even with exposed periosteum or bone), or dorsum of the hand (skin only), or lower leg, but in theory it can be used all over the body.

It will create an odd looking wound for many weeks, so is usually more of a pragmatic technique when time or skills are in short supply, rather than in areas where aesthetic demands are high. However it can be helpful in reducing the patch of hair loss in a hair-bearing scalp excision.

Thanks for watching.

Time points:
starts with absorbable suture dermal version
02:26 waffle robe reveal
02:57 ergonomics
04:05 how tight to pull
04:58 tensioning stitch (see separate video)
07:10 when to use it
09:48 non-absorbable version through skin