Wound closure — materials, mattress sutures and bites viva

Before LA. Document distal neurovascular and tendon function — anaesthesia abolishes re-testing. Deep layer takes tension; surface layer for everted apposition; gauge, size and removal timing per local protocol. Vertical mattress (far-far near-near) suits high-tension or rolling edges — reserve sutures where tape/adhesive alternatives are unsuitable (low-tension or facial wounds may close comparably without sutures).^[1]

Adhesive. Tissue adhesives are an acceptable alternative to sutures for simple traumatic lacerations, with no difference in cosmesis, less pain and shorter procedure time; small dehiscence risk favours sutures (NNH 25).^[2] Confirm patient selection against local wound-care protocol. Mammalian bites, punctures, infected and heavily contaminated crush wounds heal by secondary intention — irrigate, leave open, antibiotics as indicated.