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Re: staples at C/SFrom: Atkinson, Samuel M (ATKINSONS@ECU.EDU)Sun Jul 30 20:21:49 2006
Ialso have not used sutures for thirty p lus years. Long ago,data showed less tensile strength with sub cuticular sutures, especially if an intern/assistant pulls them too tight...I have changed to removing the staples prior to discharge and applying Dermabond. This way I do not see them for removal in the office (time & cost. I let the hospital eat the Dermabond cost. And yes, Dermabond gives the strength of a seven day wound when applied the first day post op plus a sterile cover. No clip marks when removed this soon. Have used Dermabond for primary closure but it needs a totally dry wound and takes longer. With spinal/epidural, anesthesia time/cost is fixed but general is expensive if you go into the next cost increment whether by the ninute,10 or 15 minutes or whatever. So I close with clips at roughly centimeter intervals to avoid gaps but not too close or tightly crimped lest I compromise circulation to skin edges. As may be appreciated this also avoids a trip to the office by a new mother with breast feeding schedules and no one to drive her there. This is probably the bradley objection. sAm atkinson,md ________________________________ From: ob-gyn-l@obgyn.net on behalf of Garry E. Siegel, M.D. ________________________________ Sent: Sat 7/29/2006 11:11 AM To: Multiple recipients of list OB-GYN-L Subject: Ob: staples at C/S Dear all: Over the last 3 years since being in a collaborative practice, many of our CNM patients who seem to be a bit more "natural" (maybe many of them have taken Bradley classes) are insistent to a fault about having subcuticular sutures, not staples, for their unplanned C/S closure. Honestly, it is almost as predictable as the sun rising in the east! When I tell them that I prefer staples, and haven't sutured skin in years (and thus am a bit out of practice), well, many seem taken aback. I have found that I don't want to tell the mechanic/gardener/plumber/electrician etc. how to do his job, yet this seems the opposite to me. What's up with that? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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