Tuesday, March 18, 2014

1. Patient controlled epidural provides better pain relief than patient controlled remifentanil for labor pain in randomized controlled trials. Remifentanil is fast on and off, which leads to less respiratory side effects in mom and baby (all opiates cross blood-placenta border), but is hard to time with contractions. Opiates have a history of insufficient pain relief for labor; they are better for visceral pain than somatic pain, so during the second stage of labor, which is mostly somatic pain, patients report significant pain with opiates. The benefit is that they are faster onset than epidurals.
2. For beautiful, less visible scars, approximate the epidermis with absorbable 7-0 suture spaced approx 1 mm apart. Injury that is confined to epidermis/papillary dermis will not scar, so if you make your sutures superficial enough, the sutures will not leave a scar (although obviously the incision will).
3. After an incision heals, the tissue will attain a maximum of 80% of its former strength; this will be attained at around 6 weeks. Someone should avoid stressing the wound for the first few weeks, but then should be encouraged to ramp up physical activity. The scar may take up to 1 year to mature; people should be advised to wear sunscreen to avoid darkening of the scar, and avoid tension/massage as that will worsen the scar as well.
4. Types of suture: chromic
-Absorbable
-Natural
-Half life 10-14 days
-Flimsy and sometimes hard to work with
-Primarily used on mucosa, particularly intraoral
-Apparently not supposed to be used on skin as it causes inflammation, although in many plastic surgeons' experiences, this is not necessarily the case
5. Types of suture: fast absorbing
-Absorbable
-Half life 3-5 days
-Very flimsy, breaks easily, hard to tie, especially 4-0 or less.
-Good for small skin openings where you just want a little help.
6. Type of suture: vicryl/polysorb 
-Absorbable
-Half life 21-28 days, 10% at ~35 days, complete absorption at 70
-Braided
-Strong
-Standard for deep closures.
7. Type of suture: maxon
-Absorbable
-Half life 28-26 days
-Monofilament
-Often used in larger caliber for abdominal fascia closures
8. Type of suture: biosyn/caprosyn
-Absorbable
-Synthetic monofilament
-Biosyn lasts a bit longer than caprosyn, half life 1-2 weeks.
9. Type of suture: nylon
-Non-absorbable monofilament
-Often used for superficial stitches (drain, superficial wound closures)
10. Type of suture: prolene
-Bright blue, non absorbable monofilament.
-Frequently used for abdominal closures.

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