Do you use viceyl deep wounds with existing open ulceration

[air bud]

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Having a discussion with a colleague...

 

[619]

I guess I am a TFP because I still don't close deep layer for wounds

 

[air bud]

Stupid voice text and I'm in the middle of wound care clinic ignore the errors here You guys know what I'm trying to do

 

[Sendin_Toes_2market]

I do 3-0 vicryl and 3-0 nylon for any wound closure unless it’s an abscess that’s not a delayed closures. The I do 2 deep prolene vertical mattress and 3 simples just to re approximately for those(really big abcess that I had to clean out a lot). If I am worried about infection why do I close it? I also only do 1 or 2 vicryl just to re approximate it. Even on clean amputation I am barely closing it. Yet to have a hematoma or seroma. I do get them from other providers when I am on call…

I’m a bare minimum guy for wound cases.

 

[air bud]

For the record I close infection cases the same way I close any other case. We went into operating room We excised all crappy tissue irrigated appropriately they're on antibiotics who cares what suture you use.

 

[heybrother]

There's nothing left to close when I'm done.

 

[Adam Smasher]

Hear me out:
Aggressive mattress sutures with 2-0 prolene to evert the hell out of the wound margins
Then staple closure to approximate the epidermis

Ruthless. Effective. Layered.

 

[Podstar]

2-0 or 3-0 vicryl depending on depth/size/tension on the incision or wound and then same either 2-0 or 3-0 nylon for skin and I’ll do staples between these for really large incisions like TMA. Evert the hell out of it and tie those knots tight to eliminate dead space and give it the best chance not to dehisce when they inevitably walk on it. I’ve never had any issues with tying knots tight and strangulating tissue leading to necrosis.

I have had a few people spit the vicryl sutures in wound/infection cases but never had it become a real issue all of them have either just healed back over it or I just cut them out and do wound care for a bit and it heals.

 

[air bud]

I've stopped doing horizontals. I may do them to avert it and then I'll pop those and replace with simples. I also will do simples and then fill gaps with Staples. I used to get incision problems on elective stuff because I was over tightening horizontals and once I stopped and went to all symbols no more incision problems. Verticals I do ok with. Horizontal always see problems

It's funny training surgical assists on foot and ankle stuff.... You'll see them use some pickups and grab that tissue and it's like bro this isn't a g*d damn abdomen. You respect the hell out of that soft tissue You look at it wrong it will dehis.

Also 3-0 prolene PS2 is the greatest suture out there for foot ankle

 

[josebiwasabi]

I use 2-0 or 3-0 PDS for deep closure in infection/amp cases. It's a monofilament but it's stronger and longer absorption time so it's less reactive compared to vicryl.

Skin is closure with 2-0, 3-0, or 4-0 prolene depending on where I am on the foot/ankle.

 

[Feli]

There was a thread about vicryl roughly 12 years ago... locking.

 

[Hybrocure]

If I close and need deep suture I’ll use vicryl ulcer or not. The vicryl isn’t introducing bacteria. If bad **** is there it’s gonna do its thing whether or not vicryl is used or not

 

[Hybrocure]

I've stopped doing horizontals. I may do them to avert it and then I'll pop those and replace with simples. I also will do simples and then fill gaps with Staples. I used to get incision problems on elective stuff because I was over tightening horizontals and once I stopped and went to all symbols no more incision problems. Verticals I do ok with. Horizontal always see problems

It's funny training surgical assists on foot and ankle stuff.... You'll see them use some pickups and grab that tissue and it's like bro this isn't a g*d damn abdomen. You respect the hell out of that soft tissue You look at it wrong it will dehis.

Also 3-0 prolene PS2 is the greatest suture out there for foot ankle

Im more
Of a Nylon guy myself

 

[DYK343]

Woah woah woah.

So this question started with me stating to airbud that I am trying to back off from keller arthroplasties for plantar hallux ulcers due to problems with dehiscence.

He asked why I was getting so much dehiscence. I said neuropathy with increased ROM of the 1st MPJ and I think because I am not doing deep vicryl closure with open plantar hallux wounds.

He subsequently referred to me as a TFP. "I close an infected wound just like I close a regular wound" meaning he does vicryl in an infected wound then skin closure.

I then pointed out literature says no vicryl in contaminated/infected wounds (which I then pointed out following evidence based medicine actually makes me actually anti-TFP).

He then started this biased worded poll. I demand a recount/repoll!


................

And before anyone asks if I am doing a keller its because the wound is pretty bad. Not for a wagner 1. Patient is facing amputation without intervention.

Delayed primary closure - after at least 2 debridement's, packing open/dressing changes, IV antibiotics, I do use deep closure but not vicryl.

 

[Hybrocure]

Woah woah woah.

So this question started with me stating to airbud that I am trying to back off from keller arthroplasties for plantar hallux ulcers due to problems with dehiscence.

He asked why I was getting so much dehiscence. I said neuropathy with increased ROM of the 1st MPJ and I think because I am not doing deep vicryl closure with open plantar hallux wounds.

He subsequently referred to me as a TFP. "I close an infected wound just like I close a regular wound" meaning he does vicryl in an infected wound then skin closure.

I then pointed out literature says no vicryl in contaminated/infected wounds (which I then pointed out following evidence based medicine actually makes me actually anti-TFP).

He then started this biased worded poll. I demand a recount/repoll!


................

And before anyone asks if I am doing a keller its because the wound is pretty bad. Not for a wagner 1. Patient is facing amputation without intervention.

Delayed primary closure - after at least 2 debridement's, packing open/dressing changes, IV antibiotics, I do use deep closure but not vicryl.

DPC after two debridements for a mtpj wound how mad are the hospitalists with those 2-3 week stays

 

[DYK343]

DPC after two debridements for a mtpj wound how mad are the hospitalists with those 2-3 week stays

I dont follow.

Do your DPCs take 2-3 weeks?

I dont do any DPC for an ulcer. I&D/Amp sure

Re-reading my post perhaps I wasnt clear. My statement under the dotted lines was a comment to quell the "well how do you do a DPC then?" which is deemed clean after at least 2 debridements and packed open for several days. Which is still no where near 2 weeks. I also dont use vicryl when there has been infection present for DPC which is the point of this thread.

 

[msion]

Or use Vicryl Plus, that thing is coated with Triclosan, which kills both bacteria and fungus, just in case if your suture gets caught on that crumbly nail.
Problem solved.
Now let's lock the thread.

 

[wakaflocka88]

Don’t use tourniquet
Use wheaties/gelpies
3-0 PS2 prolene vertical mattress or simple
No hemiguard unless you’re a ***** or TFP
2-0 vicryl for everything

You do not need a wound care or limb salvage fellowship to learn simple principles.

 

[Hybrocure]

Don’t use tourniquet
Use wheaties/gelpies
3-0 PS2 prolene vertical mattress or simple
No hemiguard unless you’re a ***** or TFP
2-0 vicryl for everything

You do not need a wound care or limb salvage fellowship to learn simple principles.

tbh if there is no pus or gas I’d even wager tourniquet is the way to go. Easy visualization to cut get in and get out without constant suction

 

[Sendin_Toes_2market]

tbh if there is no pus or gas I’d even wager tourniquet is the way to go. Easy visualization to cut get in and get out without constant suction

Blood is good. Plenty of Plasma. If it’s good for tendons it’s good squirting out of my diabetic wound. Basically a 0232T.