Re: Ob: staples at C/S
From: Kim Elise Goldman (goldman@calweb.com)
Sun Jul 30 20:56:34 2006
I am sorry you had a bad experience; that doesn't mean that all
sutures are bad or all staples are good.
The only sutures I ever had any problems with were the vicryl sutures
placed by an OB in an UNNECESSARY episiotomy almost 23 years ago. 10
years later I had the suture granulomas removed and allowed the
resulting 2 cm in diameter wound to heal by secondary intention. 17.5
years after that first birth I had a second one without unnecessary
interventions.
I have had sutures and, as a surgeon, place them all the time on
people's faces and scalps not to mention donor sites such as abdomen
(fat graft harvest), hip, chest and knee (bone donor sites). We don't
seem to have the kinds of problems that are being reported here with
suturing. I usually place both subcutaneous sutures (not pull out)
and skin sutures (proline) which I remove at appropriate time
interval (sooner on face than on abdomen, hip, knee or chest).
No one is arguing that one cannot get an esthetic closure with
staples. My only point was that for patients sutures are both more
comfortable (usually) and frankly less frightening to look at.
Kim
On Jul 30, 2006, at 9:33 PM, Atkinson, Samuel M wrote:
> I h.ad a pseudoaneurysm repaired under local and was given choice
> of closure..I chose clips and had a first year female resident
> (gyn) take them out. I had a carotid with US surgical sub cu and
> extruded it for 5 weeks. Obviously you have not been a pt very often.
> sAm
>
> ________________________________
>
> ________________________________
> From: ob-gyn-l@obgyn.net on behalf of Kim E. Goldman
> Sent: Sat 7/29/2006 1:20 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Ob: staples at C/S
>
> FWIW,
>
> Neurosurgeons almost always staple their craniotomy skin incisions.
> I almost always suture mine. Why? Because it feels nicer to the
> patient. It is NOT as quick but if you are the one walking around
> with it, it feels a whole lot better.
>
> Maybe that is why patients and/or midwives are requesting sutures
> rather than staples?
>
> Just a thought.
>
> Kim
>
> On Jul 29, 2006, at 11:55 AM, DoctorJoe@aol.com wrote:
>
> In a message dated 7/29/06 10:11:03 AM, garrys@mindspring.com writes:
>
> 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?
>
> Well, in parsing your post, the first thing I'd think is - what
> are the CNMs TELLING their patients about staples versus
> subcuticular stitches? Sounds like educational variation to me. You
> can always "brainwash" a patient given enough time. Is that what's
> going on?
>
> As for me, I always liked staples better. They give IMHO a
> straighter scar. They come out, hence, do not tend to stay in situ
> and cause (in some cases) more inflammation and sometimes a thicker
> scar. And I always took them out and places steristrips on Day 2 or
> 3, and I did it myself. So that meant I actually TOUCHED the
> patient and rubbed on her belly, so to speak. I think that
> 'bonding' is worth more than the actual technical question itself.
> And oohing and ahhing over how nice the incision looks is a
> positive thing, esp. in a patient with an unplanned C/S (i.e. in a
> patient who has "failed" in her birthing plan).
>
> And no, you wouldn't argue with a "professional" about his job,
> e.g. the plumber or electrician. You WOULD argue with the waiter
> about the way your food was prepared. So does that make you feel
> like more of a "server" than a "professional?" It should.
>
> And therein lies one of the major problems with medicine today.
> Patient and doctor? No. Server and consumer? Yep. We've gone beyond
> the intermediary stage of "client."
>
> Joe P.
>
> <winmail.dat>
