Wound closure — material, technique, and secondary intention

(a) Layered forearm closure. After irrigation and debridement to healthy bleeding tissue, document distal neurovascular/tendon function before local anaesthetic. Close deep dermis/subcutis with absorbable suture (e.g. 4-0 Vicryl) to take tension, then epidermal apposition with non-absorbable monofilament (e.g. 4-0 nylon) using interrupted or mattress technique with edge eversion. Avoid strangulating knots.^[1]

(b) Cat bite. Mammalian bites inoculate oral flora (including Pasteurella); primary closure traps bacteria and drives deep infection, especially in the hand. Clean, irrigate, debride necrotic tissue, leave open (secondary intention or delayed primary), elevate, start amoxicillin-clavulanate, early review, tetanus update. Tissue adhesive is inappropriate for infected/contaminated bites.^[2]

(c) Gauge and removal. Typical gauges: face 5-0, body 4-0, scalp/extremity 3-0. Removal: face ~5 days (prevents cross-hatch scarring), scalp/body 7–10 days, joints ~14 days because motion delays tensile strength. Paediatric facial wounds may use rapidly absorbing suture to avoid removal visits.^[1][3]