| Course | PA 532 Surgical and Clinical Skills |
|---|---|
| Week | 6 |
| Paper type | Wound closure rationale |
| Length | About 650 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 532 Week 6
Wound Closure Rationale for a 4 cm Table Saw Laceration on R.V.'s Left Forearm Six Hours Old: Closed Now, in Two Layers, With Absorbable Deep Sutures and Nonabsorbable Skin Sutures, and What Would Have Changed It
Student Name
Chamberlain University
PA 532: Surgical and Clinical Skills
Instructor Name
Month Day, Year
Wound Closure Rationale for a 4 cm Table Saw Laceration on R.V.'s Left Forearm Six Hours Old: Closed Now, in Two Layers, With Absorbable Deep Sutures and Nonabsorbable Skin Sutures, and What Would Have Changed It
The Wound
Five weeks after the hernia repair, R.V. was back in the shop and cut the left forearm when a board kicked back on the table saw at 13:00. Seen at 19:00, six hours after injury. Laceration on the back of the forearm, 4.2 cm long, straight edges with a 1 cm ragged segment at one end, 6 mm deep through skin and fat, muscle fascia visible but intact. No tendon exposed. Finger and wrist extension full and strong against resistance. Sensation normal over the hand. Moderate oozing, controlled with pressure; apixaban was restarted after the hernia repair. Fine sawdust in the wound. Tetanus booster given 3 years ago.
Whether, Before With What
The first question is whether to close now. Delayed closure is chosen for wounds at high risk of infection: heavy contamination, bites, crush injuries or long delays. A prospective study of emergency department lacerations found that time to closure was not strongly associated with infection, and that wound and patient factors mattered more than a fixed "golden period" (Quinn et al., 2014). R.V.'s wound is six hours old, on a well-perfused arm, with fine sawdust that can be irrigated out, in a nondiabetic patient. Closing now is reasonable after cleaning.
The Clock Since Injury
Six hours is within the window most clinicians accept for primary closure of a clean extremity wound. Had it been 24 hours with redness at the edges, delayed closure after cleaning and a check at 72 hours would have been chosen.
Three Choices That Agree
Cleaning: irrigation with at least 500 mL of tap-quality saline under pressure, after local anesthesia, with the sawdust removed and the ragged 1 cm segment trimmed to clean edges.
Layers: two layers, because the wound is 6 mm deep, the forearm moves and skin closure alone would leave a dead space where blood could collect, a real risk on apixaban.
Materials: absorbable 4-0 sutures for the deep layer to close the dead space; nonabsorbable 4-0 nylon interrupted sutures for the skin, removed at 10 days. Tissue adhesive was not chosen because the wound is under tension over a moving forearm.
The three choices agree: a clean, deep, moving wound in an anticoagulated patient calls for cleaning, a deep layer and secure skin sutures.
Depth, Tension and What Is Under It
Fascia was intact, so no muscle repair was needed. Tendon function was tested before the anesthetic, the order that matters, because a partial tendon injury can be missed once the area is numb. Tension is moderate, increased with fist clenching, which is why adhesive was rejected.
Bleeding on Apixaban
Apixaban was not held; the timed holds used before planned surgery (Douketis et al., 2019) do not apply to an injury that has already happened, and missing doses would add stroke risk without helping this wound. Bleeding was controlled with pressure and the layered closure. A light compression dressing was applied for 24 hours.
The Wound That Would Have Changed It
If the wound had been a ragged saw injury with tissue loss, or contaminated with soil from a farm, or 24 hours old with surrounding redness, the answer would have been delayed closure. If finger extension had been weak, a tendon injury would have needed exploration and a hand surgeon. If the sawdust could not be fully removed, a delayed closure would also have been safer.
References
Douketis, J. D., Spyropoulos, A. C., Duncan, J., Carrier, M., Le Gal, G., Tafur, A. J., Vanassche, T., Verhamme, P., Shivakumar, S., Gross, P. L., Lee, A. Y. Y., Yeo, E., Solymoss, S., Kassis, J., Le Templier, G., Kowalski, S., Blostein, M., Shah, V., MacKay, E., . . . Schulman, S. (2019). Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. JAMA Internal Medicine, 179(11), 1469-1478. https://doi.org/10.1001/jamainternmed.2019.2431
Quinn, J. V., Polevoi, S. K., & Kohn, M. A. (2014). Traumatic lacerations: What are the risks for infection and has the "golden period" of laceration care disappeared? Emergency Medicine Journal, 31(2), 96-100. https://doi.org/10.1136/emermed-2012-202143
What the PA 532 Week 6 assignment asks for
The sixth week asks for a dense argument about closing a wound. Describe the wound in measurements, its depth and what lies under it, and state the time since injury. Argue first whether to close now or delay, with evidence. Then choose the cleaning, the layers and the materials, and show that the three choices agree with one another and with the wound. Address depth, tension and any underlying structures, and say when you tested function. Address patient factors, such as anticoagulation or diabetes. Close by naming the wound that would have changed your decisions. Keep it shorter than other procedural weeks. Cite evidence for timing and any medication decisions.
How this PA 532 Week 6 example is built
The rationale describes R.V.'s 4.2 cm forearm laceration from a table saw kickback, 6 mm deep to intact fascia with sawdust and a ragged end, six hours old, with full extension strength and normal sensation and a recent tetanus booster. The whether section cites Quinn and colleagues on wound and patient factors outweighing a fixed time window. The clock section explains six hours against a 24-hour alternative. Cleaning, a two-layer closure and absorbable deep sutures with nylon skin sutures are shown to agree, with adhesive rejected for tension. Tendon testing before anesthesia is recorded. Apixaban continues, with the PAUSE timed holds explained as irrelevant to an injury. A final section names ragged, soil-contaminated, late or tendon-involving wounds that would have changed the plan.
PA 532 Week 6 rubric: what full points look like
Points in this rationale start with order: discussing suture choice before deciding whether to close at all loses the most. Faculty then check the description: adjectives instead of measurements, or a missing time since injury, are marked down. Credit goes to cleaning, layers and materials that fit each other and the wound, with reasons. Underlying structures must be addressed, and testing function before anesthesia is expected. Patient factors such as anticoagulation must be handled explicitly. The counterfactual section, naming the wound that would have changed the plan, earns significant marks. Brevity matters; padding costs points. Evidence on timing and infection should be cited.
PA 532 Week 6 help: mistakes that cost points
Closure rationales often jump straight to suture size without asking whether the wound should be closed now. Send your wound details and patient factors, and the rationale built for them would measure the wound, state the clock, argue whether to close before choosing how, and show cleaning, layers and materials working together. Underlying structures and function testing are addressed, and patient factors such as blood thinners are handled. The counterfactual names the wound that would change the plan. If your wound is a bite, a facial cut or a crush injury, the decisions change but the order holds. Describe your own wound's measurements rather than adapting the model's.
Get a PA-532 Week 6 example written to your instructions
The wound scenario your section posted belongs in the request along with the instructions, and a custom PA-532 closure rationale is written around that wound and returned inside 24-48h, the first one free. Where your classroom names a specific text for materials and intervals, name it and the sample argues from that source.
More PA 532 papers and MPAS samples
- PA 532 Week 1: Procedure Limits Discussion Post
- PA 532 Week 2: Surgical Indication Brief
- PA 532 Week 3: Preoperative Risk Summary
- PA 532 Week 4: Informed Consent Script
- PA 532 Week 5: Procedure Step Sequence
- PA 532 Week 7: Postoperative Day Plan
- PA 532 Week 8: Complication Timeline Analysis
- PA 531 Week 6: Time-Bounded Workup Plan
- PA 530 Week 6: Spine Red Flag Brief
- PA 528 Week 6: Episodic Symptom Timeline
- PA 526 Week 6: GI Bleeding Source Triage
PA 532 Week 6 questions, answered
Which closure material should the example use?
Whichever the scenario and your assigned source support, named specifically rather than described in general terms. Marks come from the reasoning that gets you there, so a defensible choice argued from site, depth and tension outscores a fashionable one asserted. If your section prescribes a formulary or a single text, the sample follows it.
Do I have to discuss leaving the wound open?
In most sections, yes, at least briefly, because the delayed and secondary options are what make the primary decision a decision. Dismissing them takes a sentence apiece with a reason. Papers that never mention them read as though closure was assumed from the start, which removes the argument the week is built to assess.
How is the removal date justified?
By where the wound is and how much tension it carries, with the source for the range named. The date is the end of an argument rather than a fact to be looked up, and a rationale that states an interval without connecting it to the region and material has broken the set the marker is checking for consistency.
Where can I find a free PA 532 Week 6 sample paper?
The full PA 532 Week 6 closure rationale is on this page, a 4 cm saw laceration closed in two layers six hours after injury.
Why was tissue adhesive rejected in the PA 532 Week 6 sample?
The wound sits over a moving forearm under moderate tension, which adhesive cannot hold reliably.