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What is the logic for leaving the ostomy site open and packing it after reversal? Why not just suture it closed?
I do something similar by closing the edges with staples and pack the very center with iodoform or gauze, depending on size. Usually heals up quickly unless the patient is obese. After changing stoma bags for a while, I find patients aren't too freaked out by packing a wound.I suppose it doesn't help my stats and perhaps will one day make my reimbursement suffer, but I close the ostomy site loosely over a penrose and accept that some will still get infected. All the ones that don't (and even some of the ones that do if it is mild) appreciate not having to pack a big wound and have a bigger scar. I do use staples though so it is easy enough to pop them out.
InterestingMy attendings range the gamut from closing it completely, closing over a drain, to laving it wide open.
My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.
My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.
we do exactly the same!My attendings range the gamut from closing it completely, closing over a drain, to laving it wide open.
My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.
We use PDS. I've still only ever heard of and never seen this Maxon stuff.
Equivalent I suppose, but actually a different polymer (unlike the others which are the same substance). I too have never seen Maxon.Same thing, as you know. US Surgical/Covidien sutures but essentially the same stitch. Maxon=PDS, caprosyn=monocryl, polysorb=vicryl, Ticron=Ethibond, silk=silk, surgipro=prolene, chromic=chromic.
In general, I prefer the ethicon stuff, but it's been 5 years since I've had unrestricted access to them, so I've been forced to adjust.
it'd blow your mindEquivalent I suppose, but actually a different polymer (unlike the others which are the same substance). I too have never seen Maxon.
Is it pretty? I judge suture by aesthetics alone.it'd blow your mind
I wouldn't know it's so majestic I haven't been able to look directly at itIs it pretty? I judge suture by aesthetics alone.
That's the argument I've heard for why we use maxon on the bile duct but I don't actually know the dataI thought there was data that Maxon degrades faster than PDS? I've never looked up the source admittedly; that's just what I've been told...