October 8th, 2009 by RamonaBatesMD in Better Health Network
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I want to share this section of the old textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD (1908) mainly because I want to share the photo of the “angular knife for incision of the tympanic membrane” with you.
Otitis Media
This is a common disease of childhood, usually following a cold in the head. The prominent symptom is earache. Every physician ought to be able to recognize the bulging outward of the membranum tympani and to relieve the pressure by incision of the membrane at the most favorable situation – viz., the inferior and posterior portion. The introduction of warm olive oil into the external meatus will sometimes relieve pain, and the application of external heat may also be tried; but the pain of a severe earache, unless relieved by puncture of the membrane, usually demands the internal administration of morphine. Read more »
*This blog post was originally published at Suture for a Living*
October 1st, 2009 by RamonaBatesMD in Better Health Network, True Stories
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This topic has become more real for my family. My first cousin’s son-in-law committed suicide this past weekend. He had had difficulty adjusting since his return from Iraq, but the family was still caught off-guard. If you can make it any worse, he chose his wife’s birthday to take his life. Fortunately, neither she nor their toddler son was home at the time.
The issue of soldier suicide concerns many. Maj. Gen. William D. Wofford, Arkansas’ National Guard Adjutant General, recently made a public plea for help asking family members, friends and employers of the state’s 10,000 Guardsmen to watch for personality changes or signs of stress overwhelming his soldiers and airmen. There has been four suicides in Arkansas Guardsmen since January.
Read more »
*This blog post was originally published at Suture for a Living*
September 24th, 2009 by RamonaBatesMD in Better Health Network, Medical Art
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The surgical dressings section of the old surgery text, A Text-Book of Minor Surgery by Edward Milton Foote, MD, I first mentioned on Monday is very interesting.
Cotton
Cotton in its raw state has very little absorbent power because of the oil and gum with which its fibers are covered. When the cotton has been bleaches by chemicals, and the oil extracted, its absorbent power is very great. This fact, together with its cheapness and lightness, the toughness of its fiber, and its ready sterilization by steam or dry heat make it almost the ideal material for surgical dressings.
Unbleached Cotton
This is cotton in its natural state, freed from dirt, combed, and put up in pound rolls. It is non-absorbent and has a greater elasticity than the absorbent cotton. It is therefore preferable as a padding for splints, and to diffuse the pressure of a non-elastic bandage….It costs about thirty five cents a pound…..
Absorbent Cotton
as supplied by the manufactures of surgical dressings, is freed from dirt, gum, and oil, combed and sterilized, and so wrapped in tissue-paper that with a little care it remains aseptic until it is all used. It is furnished in packages of various sizes, from a half ounce to one pound, costing thirty-five cents a pound in pound packages. On account of its lack of elasticity, it is inferior to unbleached cotton as a padding for splints, etc.
Dry cotton is not a suitable material to bring into contact with a wound either during operation or afterward. In the former case its fibers are likely to stick to the wound, and also to the fingers of the operator. In the latter case, if the discharge is small, it is likely to evaporate and seal the cotton to the wound or to the surrounding skin with a scab which is difficult of removal. If cotton is used for sponging, during an operation, balls of suitable size should first be saturated with saline or some antiseptic solution, and then squeezed dry.
Substitutes for Cotton
Lamb’s Wool
Lamb’s wool has great elasticity, does not become soggy when exposed to moisture, and absorbs readily oily substances and glycerids. When cleaned and sterilized it is therefore an excellent material for vaginal tampons.
[So very different from today!]
Gauze
Bleached absorbent gauze is the most important item in surgical dressings. The firmness of the material varies according to the number of threads to the inch. The quality should be selected according to the purpose for which it is desired. Thus a gauze which has 24 X 32 threads to the square inch is suitable for sponges or for dressings, but has not sufficient firmness to make a good bandage. On the other hand, a gauze with 40 X 44 threads to the square inch, used for bandages, is unnecessarily expensive when used for sponges or dressings. It is, however, an unwise economy to select for sponges and dressings a gauze with too large a mesh. Such a gauze absorbs so little that an additional quantity is required in every case, so that the total expense is very likely increased.
Gauze suitable for sponges and dressings, have 26 X 32 threads to the four to five cents a yard, by the piece of 100 yards. This price is increased to eight or even ten cents a yard when the gauze is purchased in small pieces, previously sterilized and hermetically sealed.
Unbleached Muslin Read more »
*This blog post was originally published at Suture for a Living*
September 16th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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I’m sure I don’t see as many patients with common skin warts as my family practice or dermatology colleagues, but these patients still make it to my office. Sometimes it’s the primary complaint, sometimes it’s an afterthought. In reviewing the topic, it occurred to me that most patients don’t need to see any of us for this problem. They mostly need to accept the fact that the treatment takes TIME. So if you will persist, then you will often be successful without the expense of seeing a doctor. (photo credit)
Common warts (Verruca vulgaris) are caused by the human papillomavirus (HPV). Warts on the hands or feet do not carry the same clinical consequences of HPV infection in the genital area. It is estimated about 10% of children and adolescents have warts at any given time. As many as 22% of children will contract warts during childhood.
Common warts can occur anywhere on the body, but 70% occur on the hand. Often they will disappear on their own within a year. Even with treatment, warts can take up to a year to go away.
Before heading to the doctor, there are treatments you can try at home: salicylic acid or duct tape.
When using the 17% salicylic acid gel (one brand name: Compound W), it must be applied every day until the wart is gone. Only apply to the wart, not the skin around the wart. This treatment is enhanced by covering the wart with an occlusive water-proof band-aid or duct tape after applying the acid. It can also be enhanced by gently filing the wart with an emery board daily to remove the dead cells prior to applying the salicylic acid. Treatment can take weeks to months. Don’t give up early.
Duct Tape can take weeks or months to be effective. Apply the duct tape to the wart and keep it in place for six days. After removing the tape, soak the wart, and pare it down with a filing (emery) board. Repeat the above until the wart disappears. Once again, don’t give up early.
The two treatments (salicylic acid and duct tape) can be combined. Apply the salicylic acid liquid to the wart before bedtime. After letting it air dry for a minute or so, then apply the duct tape over the wart, completely covering the area. Remove the duct tape the following morning. Each time you remove the tape, you will be debriding some of the wart tissue. Repeat the application each night, until there is no remaining wart tissue. As with using only one treatment, don’t give up early.
If the above don’t work or you just don’t want to take the time, then you may wish to see your physician for removal. He can use cryotherapy to destroy the wart. This method may involve repeated treatment over several weeks. You can do the following to “get the wart ready for removal” and make the cryotherapy more effective:
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Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel (one brand name: Compound W) on it.
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After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
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Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor’s office.
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After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.
If none of the above work, then your wart may need to be removed surgically. Remember the above all take time, so give them time to work. Even if the wart disappears with any of the above treatments, it may recur later.
Sources
Treatment of Warts; Medscape Article, May 27, 2005: W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD
What Can Be Done About a Hand Wart That Keeps Reappearing After Removal?; Medscape Article, May 31, 2007; Richard S. Ferri, PhD, ANP, ACRN, FAAN
Duct tape and moleskin equally effective in treating common warts; Medscape Article 2007; Barclay L.
Duct Tape More Effective than Cryotherapy for Warts; AAFP, Feb 1, 2003; Karl E. Miller, M.D.
*This blog post was originally published at Suture for a Living*
September 10th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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This past week I was once again asked about suture allergy. It has prompted me to revisit the issue which I have posted about twice now. (photo credit).
Sutures by their very nature of being foreign material will cause a reaction in the tissue. This tissue reactivity is NOT necessarily a suture allergy.
Many factors may contribute to suture reactivity.
- The length of time the sutures remain. The longer the sutures are in, the more reactivity occurs.
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The size of the sutures used. The larger the caliber of the suture, the more reactivity. The increase of one suture size results in a 2- to 3-fold increase in tissue reactivity.
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The type of suture material used. Synthetic or wire sutures are much less reactive than natural sutures (eg, silk, cotton, catgut). Monofilament suture is less reactive than a braided suture.
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The region of the body the suture is used affects tissue reactivity. The chest, back, extremities, and sebaceous areas of the face are more reactive.
In general, accepted time intervals for superficial suture removal vary by body site, 5-7 days for the face and the neck, 7-10 days for the scalp, 7-14 days for the trunk, and 14 days for the extremities and the buttocks. The deeper placed sutures will never be removed.
Sutures meant to dissolve (ie vicryl sutures) placed too high in the dermis (which happens often when the dermis is thin) can “spit” several weeks to several months after surgery. This is a reactive process, NOT a suture allergy. It usually presents as a noninflammatory papule (looks very much like a pimple) and progresses with extrusion of the suture through the skin. The suture material may be trimmed or removed if loose, and it is not needed for maintaining wound strength. Rarely does this affect the scar outcome.
The remaining portion is a “repost” about suture allergies:
Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.
Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.
MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).
PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).
VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan). [In rechecking facts, I found that only Vicryl Plus has the triclosan, so simple vicryl or coated vicryl should be okay.]
Surgical Stainless Steel Suture may elicit an allergic response in patients with known sensitivities to 316L stainless steel, or constituent metals such as chromium and nickel. Skin staples are surgical steel so should be used with the same precautions.
Dermabond — Tissue glues should not be used in patients with a known hypersensitivity to cyanoacrylate or formaldehyde.
SO WHAT IS LEFT TO USE
So what is left to use in a patient who may have or has a proven allergy to suture or closure material?
Silk, Dexon, Nylon (monofilament or braided), Prolene, INSORB (absorbable staples), and any of the above listed (in the allergy section) to which the patient in question doesn’t react negatively.
The choice of a particular suture material will have to based further on the wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials will be even more important to make an educated selection.
The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.
REFERENCES
Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article
Johnson and Johnson Product Information
Current Issues in the Prevention and Management of Surgical Site Infection – Part 2; MedScape Article
MECHANICS OF BIOMATERIALS: SUTURES AFTER THE SURGERY; Raúl De Persia, Alberto Guzmán, Lisandra Rivera and Jessika Vazquez
Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article
Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas
New References
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Surgical Complications;
eMedicine Article, May 29, 2009; Natalie L Semchyshyn, MD, Roberta D Sengelmann, MD
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Engler RJ, Weber CB, Turnicky R. Hypersensitivity to chromated catgut sutures: a case report and review of the literature.
Ann Allergy. Apr 1986;56(4):317-20.
[Medline].
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Fisher AA. Nylon allergy: nylon suture test.
Cutis. Jan 1994;53(1):17-8.
[Medline].
Related Posts
Allergies from Suture Material (September 7, 2007)
Suture Allergies Revisited (April 30, 2008)
Suture (June 7, 2007)
Basic Suture Techniques (June 8, 2007)
*This blog post was originally published at Suture for a Living*
