The mechanism of wound closure can either be through primary, secondary or tertiary intention. Primary intention involves the bringing together of skin edges into close apposition using sutures or other skin closure techniques, whilst ensuring there is no ‘dead space’ left in the tissue and muscle layers beneath. Secondary intention involves leaving the wound open to allow the healing processes of granulation, contraction and epithelialisation to occur, prior to closing the wound.
The most common types of wounds encountered by midwives are perineal trauma/tearing, episiotomies and caesarean section wounds. The type of wound closure depends on the wound and the preference of the obstetrician or midwife performing the repair. However, knowledge of other types of closure techniques is necessary as these may be encountered when dealing with prolonged or impaired healing, or wound drains.
The main purposes of using closure techniques are to:
- Produce a strong scar by bringing wound edges into close approximation
- Ensure the woman can continue with normal everyday functions with minimal disturbance
- Achieve a cosmetically acceptable result.
The types of suture material used fall into two categories; absorbable and non-absorbable (Table 69.1). They can be single stranded in nature (monofilament) or made of multiple filaments (braided) and the choice made is dependent on the wound, wound site and practitioner performing the repair. The major benefit of absorbable sutures is that they do not need to be removed. Absorbable sutures will hold a wound together for a definitive length of time, dependent on the material, before being digested by proteolytic enzymes or hydrolysis, whereas non-absorbable sutures require removal, otherwise they become embedded and may cause further trauma and pain.
Caesarean section wounds: