5 double-glove hole puncture indication system. When the outer glove is punctured, the colored inner glove is exposed to blood and other fluids in the operative procedure. After exposure to fluids, this double-glove puncture indication system develops the appearance of a darker color around the outer glove puncture site, a warning to operating room personnel to the presence of glove puncture of the outer glove. After noting this color change, the operating room personnel must remove all surgical gloves, wash hands and
6 don a new double-glove puncture indication system. Following needle stick injury of operating personnel, post exposure prophylaxis is mandatory.
Biology of skin wound repair
From the surgeon's point of view, the rate of gain of strength of the skin wound is a key determinant of many decisions including when the suture can be removed, the level of patient activity, and the selection of the incision. The answers to these questions are found in the results of bioengineering studies of the strength of skin wounds. Even though collagen fibers are evident on the third day after injury, the skin wound has
7 negligible tensile strength. During the first eight days after closure, the wound is held together by blood vessels crossing the wound, epithelialization, and a fibrin us coagulum. If the percutaneous sutures are removed at this time, the wound may be disrupted easily unless supported by dermal sutures and/or skin closure tapes. Over the next 13 days (8 to 21 days after injury), there is a rapid gain in strength of skin wounds.
They continue to gain strength at a relatively rapid and constant rate for four months and at a slower rate for one year. The strength of repaired skin incisions never reaches that of
8 uninjured skin. A damsons and Kahan demonstrated that rabbit skin wounds closed with a continuous 4-0 silk suture regained only 40% of the strength of unwounded tissue 120
9 days after wounding. In the dog, Van Winkle and associates noted that skin wounds approximated by different percutaneous sutures developed 70% of their normal strength by 120 days. Consequently, the skin wound remains a relatively brittle structure that is capable of absorbing much less energy than normal skin.
The diminished tensile strength of wounded skin as compared with normal skin can be