Wound Closure and Management

The management of incisions and decisions on closure techniques for surgical wounds are driven by expected incisional morbidity and the severity of the potential morbidity for the patient.

This article reviews current literature on the potential strategies to be considered in closing the skin and fascia of incisions.

The review of the literature indicates that low-risk wounds for infection should be closed primarily with subcuticular suture, and adjunctive local measures should be avoided. Adjunctive measures of irrigation, topical antimicrobial agents, and negative pressure incisional therapy may have a role in high-risk wounds. Surgeons should strongly consider primary closure of contaminated wounds.

The overall literature on adjuncts of wound irrigation, topical antimicrobials, and negative pressure wound therapy have potential to be of benefit but additional investigation is necessary since they do impact cost, patient experience, and antibiotic stewardship.