Closing wounds under tension

In large animal practice, we often have to close wounds that are under tension.  This isn’t commonly an issue in dogs and cats. Ruminants, because of rapid wound contracture, often will do fine even if you don’t close the wound. However, it is good to know several different ways to manage wound closure with tension as you may want to use a combination and some work better in some instances.

This video series takes you from mass removal (a common reason for needing to close a wound under tension) through several options  including undermining, knot tricks and relief incisions.

Options to consider:

1. 3 clamp technique  or a temporary mattress suture in the center – this takes tension off until the suture line is advanced enough to distribute the tension
2. Undermining – creating dead space can be a necessary evil – undermine the tissue to minimize pull on the incision. This is to be avoided when possible.
3. Start from both ends – this method works by taking advantage of areas with less tension and gradually bringing the wound together
4. Tension relieving patterns – various pulley and mattress patterns are better than simple interrupteds and cruciates at relieving tension (see the following chapter)
5. Relief incisions – by creating smaller incisions that can heal well (due to the smaller size), you can remove tension on the primary wound
6. Special knots – a granny knot can be useful as it can be tightened after it is place. Other variants are performing a surgeons knot with 3 throws vs 2 (to increase friction) or lightly clamping the knot as you might with a Christmas ribbon (don’t clamp monofilament suture please).