Different factors may affect the surgeon’s decision to stitch up the joint wound cosmetically or not. Some of these factors are:

• The type and severity of the wound: Some wounds may be too large, deep, or contaminated to be closed cosmetically. The surgeon may opt for leaving the wound open or using a skin graft or flap to cover the defect.

• The location and function of the joint: Some joints may have more tension or movement than others, which may affect the healing and appearance of the wound. The surgeon may choose a wound closure technique that minimizes the risk of dehiscence, infection, or contracture.

• Patient preferences and expectations: Some patients may have cosmetic concerns or preferences about their wound closure. The surgeon may discuss with the patient the benefits and risks of different wound closure techniques and try to achieve the best possible outcome for the patient.

Therefore, the surgeon does not always stitch up the joint wound cosmetically but considers various factors and chooses the most appropriate wound closure technique for each case.

What are the different types of wound closure techniques?

Different types of wound closure techniques are used to close or cover a wound after debridement, irrigation, or surgery.

The choice of wound closure technique depends on various factors, such as the type, location, size, depth, and contamination of the wound, the availability of tissue, the blood supply, the tension, and the cosmetic and functional outcomes.

Some of the common types of wound closure techniques are:

• Primary closure: This is the direct apposition of wound edges using sutures, staples, clips, or adhesive tapes.

Primary closure is usually done for clean, small, and low-tension wounds that have minimal tissue loss and good blood supply. Primary closure can speed up the wound healing process, protect the underlying tissues, improve the function and appearance of the wound, and reduce the risk of infection.

• Skin flap: This is a procedure where a piece of skin with its blood supply is lifted or moved from a donor site to cover the recipient site (the wound). Skin flaps can be used for large, deep, or complex wounds with significant tissue loss or defect.

Skin flaps can provide better coverage and match the color and texture of the wound better than skin grafts. There are different types of skin flaps, such as advancement flaps,

rotation flaps,

island pedicle flaps, transposition flaps,

and free flaps.

• Skin graft: This is a procedure where a thin layer of skin without its blood supply is harvested from a donor site and transferred to the recipient site (the wound). Skin grafts can be used for wounds that are not closed by primary closure or skin flaps.

Skin grafts can provide faster healing and less scarring than secondary closure. There are two types of skin grafts:

split-thickness skin grafts (STSG), which include only the epidermis and part of the dermis, and full-thickness skin grafts (FTSG), which include the entire dermis.

These are some of the types of wound closure techniques that are used to close or cover a wound.

There are also other types of wound closure techniques, such as secondary closure, tertiary closure, negative pressure wound therapy (NPWT),

tissue-engineered skin substitutes,

and biologic dressings.

The selection of wound closure technique depends on the individual characteristics and needs of each wound and patient.