Glue? You've got to be kidding. Glue has the tensile strength of a gnat
f**ting in a hurricane. Steristrips will close a superficial wound every bit
as well as sutures - often better - and only ongoing haemorrhage is a
serious obstacle to their use, assuming the flaps can be easily opposed on
hairless skin.
And since when has glue somehow become a cure for wound hypertrophy or
keloid formation? If it has you ought to write that one up. No doubt
Professor Quinn has his own journal now on "ridiculous trials comparing
really bad things with each other".
Not only has glue got rather dubious tensile strength, but it really does
obscure the wound, and seals in any contaminant thereby increasing your risk
of infection. I don't mind resorting to it in scalp wounds, but like to
avoid it pretty much everywhere else.
A
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, February 13, 2007 10:04 PM
Subject: Re: LAT gel
Hang on Adrian, weren't you the one criticising poor practice? Steristrips
are a real Room 101 special for me, along with pethidine, tramadol and
weight-bearing acromio-clavicular joint Xrays. Steristrips have one use and
one use only - closing pretibial lacerations. They are otherwise a great way
to hide a wound to allow it to heal by secondary intention, completely
unhindered by any semblance of closure. They are spectacularly hopeless for
facial lacerations and particularly the pouting central submental laceration
in a drooling, teething toddler. Which just happens to be the main age group
for injury, of course. It is also a central injury and thus more prone to
become hypertrophic or frankly keloid. These wounds DO need careful
attention and closure, and the nicest way to get a fuss-free result is to
use the Mum swabs with lidocaine, doc swiftly glues one-two routine.
Steristrips? Just say no!
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 13 February 2007 01:29
To: [log in to unmask]
Subject: Re: LAT gel
To be perfectly honest John, I hardly ever suture submental lacerations in
kids. They're usually quite minor, the skin flaps invariably oppose well
with digital pressure, then steristrips will hold the flaps nicely over the
convex surface of the hairless chin, and finally, the resulting scar is not
really an aesthetic issue because of its position.
Yes, you do need the kid to half-cooperate with you as you carry out this
largely painless procedure, and yes, very young kids can't really
distinguish between what is painful and what is just frightening. That said,
our nurses - and parents generally - are usually quite happy to restrain a
kid for a largely painless procedure, but are not so keen on restraint for a
clearly painful procedure.
So, as Paul suggests, you have to be quite versatile in your surgical and
anaesthetic repertoire when it comes to kids' wounds, but in this particular
case I would avoid both (surgery and anaesthesia) by using something much
simpler. There are exceptions of course, and I've rarely had to suture a
kid's chin in my time, but very rarely.
Adrian
----- Original Message -----
From: "John Ryan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 12, 2007 10:53 PM
Subject: Re: LAT gel
> What ever happened to TAC (tetracaine, adrenaline, cocaine) ? It
> worked nicely for 'simple' lacerations under the chin in kids, you
> know; the toddler who falls on his chin. One young Cian Ryan was happy to
have wound
> sutured by Dad using TAC. (tidy result also!). I seem to remember only a
> few places produced it (? Plymouth and Cambridge) but it then became
> financially non viable to produce. Is anyone still using it ?
>
> John Ryan
>
>
> ----- Original Message -----
> From: "Adrian Fogarty" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, February 12, 2007 2:00 PM
> Subject: Re: LAT gel
>
>
>> I was intrigued by the bit "simple lacerations of the head, neck,
>> limbs
>> or
>> trunk." I don't think I've ever seen a "simple" laceration of the neck
>> or
>> trunk. Pretty much every wound I see on the neck or trunk is an incision
>> caused by a sharp implement, i.e. a penetrating wound. "Simple
> lacerations"
>> they are not, particularly if you ever see them on a child.
>>
>> But back to the subject, and the Best Bets in particular. All this
> research
>> is doing is comparing two inferior forms of management - local
> infiltration
>> versus gel application - to see which is the most inferior. Many of
>> the papers are studying the "wrong" age group, i.e. older children.
>> The technique excludes digits, a big area in paediatric wound
>> management (particularly in the under twos). And finally, I don't
>> think the "tissue distortion" argument is significant.
>>
>> AF
>>
>> ----- Original Message -----
>> From: "Atkinson, Paul" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Monday, February 12, 2007 12:01 PM
>> Subject: Re: LAT gel
>>
>> > We use it at Addenbrooke's with mixed success - took a year and
>> > lots of paperwork for approval
>> >
>> >
>> >
>> > Guideline attached - may be of use
>> >
>> >
>> >
>> > Paul
>> >
>> >
>> >
>> > Dr Paul Atkinson MRCP FCEM
>> >
>> > Consultant in Emergency Medicine
>> >
>> >
>> >
>> > Box 87, Addenbrooke's Hospital
>> >
>> > Cambridge University Hospitals NHS Foundation Trust
>> >
>> > Cambridge CB2 2QQ
>> >
>>
>>
|