Re: Single Layer vs Double Layer Uterine Closure
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Nov 6 15:10:40 2003
That's why I think continuous suture is best - locking suture is too
redundant - now -- prove it. :)
>At Thu, 6 Nov 2003, Braun, R. Daniel wrote:
>
>How important is it to close the uterus with a suture that persists?
>Anybody gone back 24-48 hours post C/S and seen how loose that suture
>is? The uterus begins to involute very rapidly and after 48 hours that
>suture isn't holding much but empty space. I suspect although I have
>never tried it or seen where anyone else has either, that if one used
>plain catgut (gone in 5-7 days) one would get just as good a repair.
>
>Dan
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
>Of DoctorJoe@aol.com
> Sent: Thursday, November 06, 2003 7:15 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Single Layer vs Double Layer Uterine Closure
>
> In a message dated 11/6/03 05:33:23, rbraun@iupui.edu writes:
>
> Chromic even less so. Isn't zero vicryl and zero
>monocryl of about equal strength to #1 chromic??? Why leave that much
>suture material around for a longer time if it doesn't add any
>strength???
>
> True.
>
> My routine was 0 Vicryl or Dexon, single layer, running-locking
>for the uterus - through and through, no attempt to isolate the
>endometrium.
>
> Then I tack all the layers of stuff together with 00 Vicryl or
>Dexon, simple running (I know THAT'S controversial - just leave'm all
>open, right?).
>
> Then close abdominal fascia with 0 again, simple running.
>
> I like the idea of Dexon or Vicryl, as opposed to Chromic,
>because of less inflammation and it stays around a bit longer. Never got
>to use much Monocryl, so I don't know how that "feels" as time goes by
>and the wound heals.
>
> I was VERY impressed, years ago, when we had a post-hysterectomy
>prophylaxis study, at the major difference in vaginal cuffs which were
>sutured with Chromic on the one hand, and Vicryl or Dexon on the other.
>The ladies with Chromic suture (which was 'standard' use at LSU for
>years) had copious discharge and inflamed cuffs, even some pain. On the
>other hand, the Dexon/Vicryl patients could have meatballs of suture up
>there (probably cases done by lower down residents), and absolutely no
>discomfort or discharge. It was dramatic and directed my thinking from
>then on.
>
> Joe P.
>
> P.S. We also did an episiotomy study on the difference and found
>the same results. I think we talked about that a few years ago here.
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
