"Layers" of fascia closure for stims

[deleted993114]

I was chatting with a new fellowship grad with whom I will be working. He had a limited number of perm stims in his fellowship, but stated that his faculty did multiple layers of fascia closure for stims. I was a little puzzled by that, I was always under the impression that there was just one layer of fascia (it is essentially a sub q procedure) as I was trained by neurosurgeons, who only closed the fascia layer.

Is it possible that some of the long stimulator implants are due to "vicryl poisoning" or "too many layers" of closure? The way I see it, we have one incisional fascia layer, then secure the anchor to the second layer. Does anyone do multiple "layers" of fascia closure? If so, exactly what are these layers? I would contend that perhaps with these multiple layers, people are actually suturing fat (no purpose there) and not fascia.

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[drusso]

I think some people like to close "deep" and then close the skin. What else is there?

 

[BobBarker]

Close scarpa’s with vicryl. Skin with staples. I did take a tip from a fellow poster and throw a couple monocryl interrupted sutures subdermal. It helps keep your wound edges from overriding/undermining with a better result at staple removal.

 

[gdub25]

I agree, close fascia with 2-0 vicryl and then I do sub-q with 3-0 vicryl and staple skin. Closing multiple layers means folks are suturing fat.

 

[dhcofc]

Just run a subQ monocryl to approximate skin and dermabond over it instead of stapling. Faster, cleaner. Don’t have to remove staples then.

 

[jsaul]

on the same note,
how are folks typically closing for vertiflex placement

 

[SommeRiver]

Vicryl fascia and monocryl subcu. Steri Strips skin.

 

[pmrmd]

Staples for SCS and subQ monocryl/dermabond for Vertiflex


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[BobBarker]

I throw one vicryl deep and 2-3 monocryl simple interrupted sutures on vflex.

 

[deleted993114]

I think some people like to close "deep" and then close the skin. What else is there?

I agree- one layer of fascia then staples to close. The guy who taught me stim was a neurosurgeon who contended that (as staples pinch the skin) there is not a “highway” for bacteria from the skin to the incision.

To each his own, but I can say one layer of fascia and staples is fast.

One of my neurosurgeon partners who was retiring told me the two best things you can do to minimize risk if infection is:

Dry field

Not too many sutures