In addition to sutures and staples, surgeons sometimes use adhesives on the skin to close wounds. Glue seals the skin, and patients treated with adhesive may not require a follow-up with their doctor. Over time the glue wears away and new skin cells replace it, says Upvan Narang, director of marketing for Ethicon's New Product Development division.
While adhesives have been used in surgery for the past decade, Ethicon believes the future of the technology is its Prineo Skin Closure System, available in Europe since 2007 and pending U.S. Food and Drug Administration approval.
The Prineo system uses a dispenser, like one for cellophane tape, to lay down mesh that a surgeon then covers with glue. The combination of mesh and adhesive is strong—capable of withstanding 150 millimeters of mercury of pressure.* That's about what a patient would experience by running, jumping or coughing, Narang says. (See a video of Narang demonstrating how Prineo works.)
Although neurosurgeon Nelson has used adhesives, he says he has been "underwhelmed" by their performance. "I haven't found anything that's better at closing a wound than a suture," he says. "I like for the wound to be able to breathe, so I don't like coating it with glue." Nelson has tried Ethicon's DermaBond as well as DuraSeal, made by Confluent Surgical, Inc., based in Waltham, Mass. (Covideon also makes a tissue adhesive called Indermil.)
Surgical adhesives can also be expensive. While Ethicon says the sale price of its products varies depending on the contract with the individual healthcare facility, Nelson estimates that the surgical glues he has used cost between $500 and $800 per five-cubic-centimeter dose. (A package of 10 sutures generally costs about $150, he adds.)
Given the variety of sutures, needles and adhesives available to surgeons, it is becoming increasingly difficult to impress them. Outside of developing some better way of sealing the dura mater following brain surgery, suture makers "have come just about as far as they can come," Nelson says. "If surgeons didn't upgrade their tools for the next 100 years, no one would bat an eyelash, for the most part."
*Correction (05/14/09): This article originally stated that the Prineo system is capable of withstanding 150 pounds per square inch of pressure.
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Add CommentThere is the new revolutionary INSORB technology for wound closure that is growing in acceptance as a superior modality for surgical wound closure, offering the speed of metal staples with the comfort and cosmesis of absorbable sutures. INSORB technology can rapidly place miniature absorbable staples in the dermis beneath the skin surface holding the wound securely and not apparent to the patient. The staples dissolve after the wound is healed and leave less scar than typically seen with sutures or metal staples. Visit insorb.com
Reply | Report Abuse | Link to thisfor more information on this exciting and novel technology.
I had surgery to repair an aortic aneurism (life threatening) last year. All I can say is that my surgeon did an outstanding job - considering that he had to bisect across the entire abdominal muscle and then "go in" manually all the way to the aorta which lies against the spine.
Reply | Report Abuse | Link to thisAdvised beforehand that I'd be in ICU for 1 to 3 days: I was out in just a few hours and awake 7 hours after surgery began. Damned miraculous what they can do today! Only - those darned steel staples (54 of 'em) were "annoying" for the next couple of weeks.
Anyway: the Science that goes into Medicine - which keeps many people alive who otherwise would die - is reason enough to side with scientists and doctors over "faith based" anything.
Regarding the problem of leaky dura mater closures: Rain gear manufacturers have been using a flexible glue-like seam sealant to keep the water from seeping through the needle holes for years.
Reply | Report Abuse | Link to thisCould the Prineo or similar material mentioned in the article serve the same purpose?
About a year ago I had surgery for the removal of a run-away parathyroid gland. While I was still in recovery, I received a "get well" card from my brother-in-law which featured a drawing of someone wrapped in duct tape and a sentiment hoping that I was feeling better. Shortly thereafter when I was somewhat mobile, I saw myself in the bathroom mirror. Lo and behold, there were a series of vertical strips running from one side of my neck to the other which looked very much like duct tape. I don't know exactly what these were, but after they were removed a week or two later, there is no scar that I can find, there was absolutely no pain at all, and I feel a hell of a lot better.
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