Technical Considerations for Wound Closure: A Plastic Surgery Perspective Part I

Although most interventional radiology (IR) access wounds are small, they frequently occur in physiologically high-risk patients-including those who are anticoagulated, vasculopathic, diabetic, immunosuppressed, or previously irradiated. Even minor wound breakdown in this population can lead to hematoma, infection tracking to grafts or devices, pseudoaneurysm exposure, and reintervention. This invited review discusses reconstructive surgery principles and delves into a practical IR workflow to reduce wound complications. We focus on actionable strategies: hemostasis-first closure, preservation of marginal perfusion, tension offloading, shear mitigation, and dead space control. A rapid preclosure assessment framework evaluates patient physiology, wound edge viability, contamination, mechanical stress, and hematoma potential before committing to closure. Primary closure techniques are discussed with an emphasis on layered repair, suture selection, fragile skin management, and site-specific considerations for high-risk regions such as the groin and upper limb. Indications for delayed primary closure and incisional negative pressure wound therapy (NPWT) are highlighted. Common failure modes-including hematoma, edge necrosis, and infection threatening vascular grafts or devices-are addressed with corresponding reconstructive responses. A range of common and useful wound dressings and their indications are also discussed. Integrating microvascular principles and biomechanical awareness into routine IR wound closure may reduce complication rates, improve access site durability, and minimize the need for reintervention in high-risk cohorts.