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Re: OB: Post-op C/S wound management From: art fougner, md (evsono@pipeline.com) Wed Aug 9 14:51:20 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Chelsea Syzmanski: "Reconstruction surgery for newborn mothers vaginal canal area" Previous message: Richard Chudacoff, MD: "Re: VBAC" In reply to: Eberhard W Lisse: "Re: OB: Post-op C/S wound management" Next in thread: Eberhard W Lisse: "Re: OB: Post-op C/S wound management" Reply: Eberhard W Lisse: "Re: OB: Post-op C/S wound management" here are some pertinent abstracts - seems as tho both sides have adherents - what a shock! ( TIC) 1: J Reprod Med 1997 Oct;42(10):627-30 Closure of Pfannenstiel skin incisions. Staples vs. subcuticular suture. Frishman GN, Schwartz T, Hogan JW Department of Obstetrics and Gynecology, Women & Infants' Hospital, Brown University, Providence, Rhode Island, USA. OBJECTIVE: To compare skin closure with staples and subcuticular suture. STUDY DESIGN: Obstetric patients undergoing cesarean section with a Pfannenstiel incision were prospectively randomized to skin closure with staples or subcuticular suture. Pain and cosmesis were assessed postoperatively. RESULTS: Patients reported significantly less pain following subcuticular closure at both the time of discharge (P < or = .01) and the postoperative visit (P < or = .002). Incisions closed with subcuticular suture were found to be more cosmetically attractive by both patients (P = .04) and physicians (P .01) at the postoperative visit. CONCLUSION: Pfannenstiel skin incisions closed with subcuticular closure following cesarean section result in less postoperative discomfort and are more cosmetically appealing at the six-week postoperative visit as compared to incisions closed with staples. Publication Types: Clinical trial Randomized controlled trial PMID: 9350017, UI: 98010947 2: Br J Surg 1992 Nov;79(11):1172-3 Closure of laparotomy wounds: skin staples versus sutures. Ranaboldo CJ, Rowe-Jones DC Department of Surgery, Poole General Hospital, Dorset, UK. To investigate the routine use of a skin stapling device for the closure of midline abdominal wounds, 48 patients were randomized to receive skin staples or subcuticular polydioxanone sutures. The mean (range) time for closure with staples was 8.0 (3.4-14.8) s cm-1 while subcuticular closure took 12.7 (9.6-28.0) s cm-1. The mean time saved per patient with skin staples was 77 s. Wound pain and requirements for analgesia were significantly lower in the sutured group. The mean cost per patient was 1.41 pounds for subcuticular closure and 7.72 pounds for stapling; the latter also incurred an additional cost of 6.27 pounds for staple removal. No clear benefit derives from the use of staples in the closure of abdominal wounds. Publication Types: Clinical trial Randomized controlled trial PMID: 1467895, UI: 93105076 3: S Afr Med J 1982 Sep 4;62(11):371-2 A comparison of a disposable skin stapler and nylon sutures for wound closure. Meiring L, Cilliers K, Barry R, Nel CJ A disposable skin stapler (Proximate; Ethicon) was compared with conventional nylon sutures in respect of time taken for wound closure, cosmetic result and ease of application and removal. It was found that a time saving of 80% is possible with the stapling device, and that the cosmetic result with staples is as good as if not better than that with nylon sutures. A certain amount of experience and practice facilitates the use of the stapler. Publication Types: Clinical trial Controlled clinical trial PMID: 7112304, UI: 82277611 art At Wed, 09 Aug 2000, Eberhard W Lisse wrote: > >In message <62l1pscs3u36mavhq8p6vp4jbf5k262svi@4ax.com>, Paul Prior MD writes: >> On Tue, 8 Aug 2000 13:46:38 -0500, Eberhard W Lisse <el@ac.lisse.na> >> wrote: >> >> >I am extremely annoyed by the way, that staples are being advanced >> >with the reasoning that it is faster (for the surgeon). >> >> el - >> >> data has been published showing equal cosmetics, shouldn't speed and >> thus not only costs to health system but also anesthetic time >> therefore be a consideration? I don't see why this should annoy you. >> I use staples for all those reasons. I take them out day 2, my scars >> look just fine, thank you very much. And if I'm out of the OR 5 min >> faster with same outcome, I like that all the much better. > >Where is the evidence? > >el -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: Chelsea Syzmanski: "Reconstruction surgery for newborn mothers vaginal canal area" Previous message: Richard Chudacoff, MD: "Re: VBAC" In reply to: Eberhard W Lisse: "Re: OB: Post-op C/S wound management" Next in thread: Eberhard W Lisse: "Re: OB: Post-op C/S wound management" Reply: Eberhard W Lisse: "Re: OB: Post-op C/S wound management"

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