Longtracks - Post Op (7 of 8)
This is the same case immediately after surgery.
After the skin was excised from the right wall of the cleft, a skin flap was made from the left wall, was advanced from the left and the skin was
sutured with 2 long loose subcuticular 3/0 prolene sutures and some
interrupted 4/0 prolene sutures. The secondary opening was enlarged,
cleaned out with gauze and a curette, and used to place the drain tube.
Note that skin was excised only to reshape the cleft, to make the
cleft less deep, not to remove "weak" tissue.
The longer track, that went towards the anus, had to be incised, opened only, to clean it out (lengthening the lower end of incision) because the hair fragments could not be properly cleaned out of the track with gauze or curette.
A subcuticular suture reduces interrupted sutures needed (which are more uncomfortable to sit on). The subcuticular has to be loose or it
will cut in like a cheese-cutter at the lower exit as the patient sits down (sitting lengthens the wound as it bends). These sutures are removed on day 10. Absorbable subcuticular sutures are not used
because they are not strong enough – the wound may separate when the
patient sits. |
