542. How to close very big wounds

Very large wounds are hard to stitch up without stitch breakdown. So, how to stitch up big wounds e.g. after breast tumour removal and loss of big pieces of skin due to traumatic injury?

1. Walking sutures to combat excessive tension are not practical in distal limbs as they may damage blood vessels, nevers and tendons. They may be used in breast tumour surgeries.

Reference:
The use of skin stretching devices and their applications to Small Animal cases is well written in the Australian Veterinary Practitioner Vol 39 (3) Sep 2009.

Large wounds can be closed by
1) skin stretching, extensive undermining, application of skin grafts, axial pattern flaps and walk-in sutures
2) induced expansion of the skin eg. neck elongation of the neck custom in some Myanmarese women. One example in veterinary use is to stitch horizontal mattress anchored to tubings to stretch the skin on both sides of the big wound in the afternoon and then operate the next day to appose the skin wound after undermining. This method is shown in the reference article mentioned below.