Wound closure techniques

对于组织解剖、血供、生理特性以及生物力学特性的了解是进行皮瓣修复手术的基础，对组织处理以及伤口关闭技巧的掌握也是手术获得成功不可或缺的前提。

Wound healing

• the inflammatory phase
• the proliferative or granulation phase
• the differentiation or maturation phase

Surgical techniques

local anesthesia

incisions

在这部分提到了一个技巧“The blade is simultaneously angled to create a slight bevel”，其目的在于“The bevel created by the angled bias of the blade facilitates tissue eversion when the wound margins are approximated”， 故这个bevel应该是有上端斜向病变组织，下端斜向正常组织，切除病变缝合时皮肤会拱起形成外翻：

soft tissue technique

• single-prong tissue hook在缝合及潜行分离中的应用有助于减少组织损伤，在潜行分离中利用中指感受分离深度有助于保持在同一层面：

• 术中皮肤扩张

Wound apposition

• suture
  • intradermal sutures. 注意深度：

• Wound repair with tape
• Staples

Suture materials

suture charecteristics

• inflammatory response: Chromic and plain gut sutures are associated with significant tissue reactions;a variety of synthetic absorbable suture fibers are absorbed by simple hydrolysis, which is associated with limited inflammation. Nonabsorbable fibers do not undergo local degradation and elicit the least inflammatory response.

• natural fiber suture
• synthetic fibers
  • absorbable synthetic fibers
  • nonabsorbable synthetic fibers

• suture needles
• tissue sealants
  • fibrin sealants
  • tissue adhesives