No more wound dressing
Until recently my practice received a significant number of phone calls from patients enquiring when the wound dressing could or would have to come off, what if they peeled off in the shower after 4 days, a week, 2 weeks; what if the dressing became coloured, etc.
My secretary answers every phone call and while my girls become experienced in answering those phone calls, they are not medically trained. She would pass a message on to my practice doctor who would then return the call; but even for her as a medically trained professional, it is not easy to differentiate a “normal” worn out wound dressing from a wound infection over the phone. In doubt, my practice then often asked the patient to see their local GP to make sure no infection was brewing underneath the dressing.
These days, I don’t use wound dressings any more. I close all abdominal incisions and laparoscopic ports sites with an absorbable 3.0 monofilament suture (non-dyed!) and plus Dermabond, a glue to seal the wound instead of a dressing. Guess what: The number of phone calls requiring assistance about wounds has vastly diminished. Means: Happy patients. No more wound dressing!
Does research support what I do?
Most research compares wound glue versus established skin closure (sutures or staples). There are a handful of clinical trials and some recent trials have been conducted in emergency medicine (cuts to face, limb or skin of other regions; mostly in children), colorectal and cardiac surgery. The upshot of these trials is that there is no difference in wound infection rates and most trials report a trend towards better cosmesis (patient reported) after glue closure. The big difference is in patient satisfaction. Patients in the Dermabond group report significantly higher satisfaction rates.
The big disadvantage of skin glue is that it is not nearly as strong as a suture.
To overcome that weakness you will either need to suture the skin and use glue in addition (like I do) or use Prineo, a new combination system using a tape plus the glue. Prineo is as strong as a suture plus glue but it can be tricky in hairy areas (Pfannenstiel incisions) and it also needs to peel off. I’d be expecting phone calls from anxious patients again asking when the tape can be peeled off …
Skin glue plus sutures make a watertight, strong and cosmetically appealing skin closure. I observed that there are fewer wound infections, less scarring, and removal of sutures or stitches not required. Patients can shower immediately postoperatively and the glue will peel off slowly over weeks.
Before you apply skin glue, the wound needs to be clean and dry.
Products available in Australia:
- Dermabond (Johnson & Johnson Medical) – easy to apply. You will need 1 vial for 4 laparoscopy port sites but more to close a laparotomy wound.
- GluSeal (GluStitch, Inc) – not available in Australia
- Histoacryl (B Braun) - available in two colours: translucent (for facial use) and blue (enables visual control over the quantity applied). I find it a bit tedious to apply to the skin (very thin liquidy/runny).
- Indermil (Covidien) and Liquiband (MedlogicGlobal) are two brands of skin glue that apparently don’t sting. Hence, their use mainly in children’s emergency centres.