Methods of Wound Treatment - Suturing, Steristrips & Medical Super Glue

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Steve Netwriter
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Current Management of Facial Wounds in UK Accident and Emergency Departments
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1964044

Can We Really Use Super Glue Instead of Suture?
http://www.fensende.com/Users/swnymph/refs/glue.html

Quote:
How to use tissue adhesive:
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Although not specifically recommended for perineal repair, tissue adhesive has been successfully used by some midwives. However, Hisotcryl Blue was used in place of interrupted or subcuticular stitches in a small study of the closure of the superficial layer in mediolaterial clitorotomy (episiotomy). (Adoni & Anteby) In this study, the yoni (vaginal) mucosa and subcutaneous layers were closed with conventional suture techniques. It might be a good alternative to offer when women refuse conventional sutures. Tissue adhesive works best when the wound is moderately shallow. Midwives report that extremely shallow wounds tend to pull apart as healing occurs and usually require no closure of any kind. The wound should also have no pockets to collect lochia and should not require other sutures. However, as the study mentioned above demonstrates, it can also be used instead of subcuticular sutures after placing basting stitches.
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Tissue glue is only applied to outside surfaces to bridge over edges; do not apply it directly to raw surfaces. The wound edges should be straight and lie together naturally. Insert a tampon, then clean and dry the skin thoroughly. Have your assistant stabilize the wound edges from top to bottom (be sure the edges are matched correctly). Insert your finger between the edges and pull it out to bring them forward slightly. This is to ensure that the wound edges are not rolled inward toward each other, but meet perfectly. It could also be accomplished with a tissue forceps. Hold gauze against the area immediately below the apex to catch and drips as you apply the glue. Apply tiny dots of glue sparingly at intervals where the wound edges meet. Or, apply a bead of tiny droplets to bridge the edges. (Thick applications do not enhance bonding and tend to crack and loosen prematurely.) Products dyed blue are easier to see. (If using Histoacryl Blue, attach a 27 g. syringe needle to the ampoule hub to help control application.
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After use, the needle should be discarded and replaced with a new needle that does not have glue within its lumen.) Be careful to apply the glue on where it is needed; glue removers should not the used in the genital area. As long as no part of the tube tip or the attached needle contacts the tissue or bodily fluids, the tube can be reused.
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Use a hair dryer or fan the area dry, which takes about 30 seconds. Adhesive will stiffen when dry. Women should observe the same precautions as those who have refused sutures entirely. Bathing is not contraindicated but prolonged soaking should be avoided. Expect the adhesive to flake off in 3 to 7 days. Allergic reactions are very rare, but may include inflammation and swelling.

The Claim: Super Glue Can Heal Wounds
http://www.nytimes.com/2007/12/04/health/04real.html

SUPPER GLUE ON WOUNDS !
http://www.firstaidcafe.co.uk/forum/printer_friendly_posts.asp?TID=3260

E-letter in response to 'They're all superglues'
http://emj.bmj.com/cgi/eletters/24/3/228

Quote:
Dear Editor,
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The problem is that patients (and untrained health workers) assume that the glue should be used on skin the same way it's used to glue a broken cup: put the glue in the middle and push the edges together. Used this way the outcome is poor with either medicinal-grade or ordinary cyano-acrylate glue.
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Conflicts of Interest:
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I've used superglue to cover my own minor hand laceration, (sustained while on a camping trip) with no adverse effect.

Gel 'to speed up wound healing'
http://news.bbc.co.uk/2/hi/health/7199897.stm

Quote:
The first stage of wound healing involves an inflammatory response, stimulating white blood cells to migrate to the site of injury, and kill off potentially disease-causing microbes.
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The same white cells guide the production of layers of a fibrous substance called collagen.
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These layers of collagen help the wound heal but, because they are not laid down in the same way as tissue when it is first created, they stand out from the surrounding tissue and result in scarring.
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The Bristol team discovered that a single gene called osteopontin plays a key role in controlling this process - and developed a gel that suppresses this action.
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They found that once the gel was applied, the speed of regeneration of blood vessels around the wound, and the rate of tissue reconstruction were both accelerated.
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In addition, deposition of collagen layers was more controlled - resulting in less scarring.

pdf of all sorts of 'plaster':
http://dermasciences.com/pdf_files/DermaSciences_bandage_guide.pdf

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Picking the wounds to mend with Dermal glue
http://findarticles.com/p/articles/mi_hb4384/is_4_36/ai_n28912827/

Quote:
Don't do deep wounds. If you ignore this advice and a wound pops open within 24 hours of the injury, you can sew it back up with traditional sutures without much of a problem. If the wound pops open after 24 hours, you've made a mistake," Dr. Reynolds said pointedly.
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* Practice on a hot dog. Company representatives may offer to provide artifical skin samples, but a hot dog works just about as well, she said. The most important step to learn is how to press wound edges together so they're straight.
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Deposit the first drop on a gauze pad. The ampule containing the glue may require a hard squeeze, and then the glue can gush out fast, Dr. Reynolds warned. Establish an even flow on a gauze pad before turning to the child.
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* Build several layers of glue. Then hold the wound steady for about 1 minute. It will dry looking like crinkly plastic wrap. Bandaging is rarely necessary.
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* Don't glue the wound open. This can't be overstated: Make sure the assistant has the wound edges closed before the glue starts flowing.
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Prevent scarring. Excessive sunlight exposure will increase the chance of a wound scarring. Even dark-complexioned patients should practice sun avoidance and use sunscreen for 1 year to prevent scarring at the wound site.

With pictures:
http://www.abs-ellman.com/admin/tupian/2008103015135346.pdf

==================

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Steve Netwriter
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Dermobond Promotional Video

DERMABOND Adhesive Manufacturing Video
http://www.youtube.com/watch?v=Y0dUN2Knays

Quite interesting to see where the stuff comes from. Obviously 'promotional'.

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Steve Netwriter
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Joined: 13/11/2008
Detailed Video on Skin Surgery - Suturing & Dermabond

WARNING: DETAILED SURGICAL VIDEO

http://www.youtube.com/watch?v=TAzPDIrrcfg

Quote:
Mr Jim Frame of Springfield Hospital explains how Dermabond, the topical skin adhesive by Ethicon, a Johnson & Johnson subsidiary, works.

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Steve Netwriter
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Joined: 13/11/2008
Laceration Repair - Short vid on suturing

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