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Bioadhesives For Repair Of Childbirth Lacerations

February 17th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Research
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Bioadhesives are a reasonable alternative to sutures for repair of perineal lacerations sustained during childbirth, according to a poster presentation at last week’s annual meeting of the Society for Maternal-Fetal Medicine.

Researchers at the Hadassah Hebrew University Medical Center in Jerusalem randomized women with first degree perineal tears to either 2-octyl cyanoacrylate (Dermabond) adhesive glue or suture for wound closure. While healing and incisional pain was similar, women who received the adhesive closure were more satisfied than those who were sutured.

In Portugal, bioadhesives have been studied for closure of the top skin layer of an episiotomy repair, and found to shorten the duration of the procedure with similar outcomes to suture in terms of pain, healing, and infection.

Biologic adhesives are chemically related to Super Glue, which is ethyl-cyanoacrylate. Midwives have been using Super Glue for perineal wound repair for some time, according to Anne Frye, who has authored a book on wound closure for midwives, and who gives instructions for its use in repair of perineal lacerations. Apparently Super Glue was also used by the military during Vietnam for wound closure.

A PubMed search on Dermabond finds multiple studies of its use, from plastic surgery to mastectomy, surgical wound closure, retinal surgery, lung and gastric leak closure, and even on esophageal varices. RL Bates mentions Dermabond as an option to repair skin tears in elderly patients. This stuff is turning into the duct tape of the medical profession.

It’s important to remember that adhesives are only for superficial skin closure, as use in deeper layers can cause irritation and burning of tissues. Side effects of their use include irritation and allergic reactions and of course wound infections, and pain can always occur no matter how one closes a wound.

*This blog post was originally published at The Blog That Ate Manhattan*

Going Against Medicine: Courageous Or Foolish?

December 21st, 2010 by Michael Sevilla, M.D. in News, Opinion
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Every once I awhile a story catches my eye as I scan the news websites. There was one this morning on CNN with this catchy title: “Mom Defies Doctor, Has Baby Her Way.” The article describes a story where a mother was going to have her fourth baby. Her previous three were born via C-section. Mom did not want another C-section done, and “defied” her doctor’s order for the procedure. “You’re being irresponsible,” the patient was told.

The middle of the article talks about the current thinking and statement of the American College of Obstetrics and Gynecology saying that “it’s reasonable to consider allowing women who’ve had two C-sections to try to have a vaginal delivery.” Of course, there’s risks with proceeding with a vaginal delivery and risks of another C-section.

What’s always interesting to me are the comments following the article. I applaud the physicians who are fighting back the anti-physician sentiment and those who are pushing (no pun intended) the only home birth agenda.

In the article, this person is being held up as a hero — as someone who defied the paternalistic medical establishment and did it her way. Good for her — or is it? What if that 0.4-0.9 percent possibility of severe complication occurred and there was a problem with mom and/or the baby? What would happen then? Read more »

*This blog post was originally published at Doctor Anonymous*