In my experience , where i used all the above mentioned procedure, the easiest was continuous simple suture. Being thick , scalp wounds often tend to trickle blood and sog the dressing after staples (except the thinner part of the scalp skin)
First of all i would like to know , what kind of wound is that , primary or secondary , and the decesion of closure than determined by type of the wound . if dirty wound i will close it interrupted horizontal mattress suture , on the other hand if post op clean sugical wound i will use continuous 2/o slik suture or stapler provided that patient can effort stapler because of cost .
that a good comment. Its interesting to know that you are using silk. I do not have much exp in that. I would use ethilon. I was of the opinion that most often (or for that matter -never) di i require to use mattress suture. If the wound margins are approximating simple continuous does well. Possible due to the good vascularity. The issue of a strained approximation is different and secondary suturing using a rotation tech etc may be rewarding (luckly I have come across only a few of these!).
Staples work just fine. It is the galeal closure that makes the difference. If there is overlap at that point you have lost the battle
I agree...staples work fine if galeal closure is good.But yes if its a reop or concern for CSF leak, then we can use running lock.
All begins with gently care of soft tissues. To wash the wound with saline solution, care the anatomic and muscular planes, close galea or subcutaneous with absorbible non continuos and the skin in your preferred way.
The most important step in wound closure is good galea approximation. Once this is archived, one can go for continuous / lock/ interrupted sutures. For posterior fossa, good muscle approximation with water tight fascia approximation is important. I prefer continuous suture for skin using ethilon. During my training and initial days used to use interrupted silk sutures for scalp. I rarely use staples due to cost constraints.
Galea by delayed absorb-able and skin by stapler is preferable to me. It gives a good cosmetic value also.
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