This device is useful for shorter, traumatically induced lacerations that might require greater precision and control. The Precise Ten Shot stapler holds 10 staples that close into a smaller arcuate configuration. This stapler commonly is used for surgical incisions or long lacerations of the trunk or extremity. The Reflex One is representative of a multiple-staple device (35 staples per cartridge) with a wide staple that closes into a rectangular configuration ( Fig. Stapling devices have evolved significantly, and many products are available. 32 Patients seem to tolerate staples well while they are in place however, there does seem to be increased discomfort on removal compared with sutures. Cost has been cited as a drawback to the use of staples however, the time saved by a busy physician and the reduced need for wound closure instruments balances that factor. The time required for staple closure was approximately four to five times less than that required for suture placement.
Adult and pediatric age groups were studied. 30,31 In these studies, body regions that were chosen for the comparisons included the scalp, neck, arm/forearm, trunk, buttocks, and legs. 29Ĭlinical studies of staple use in traumatic lacerations showed that, compared with standard suturing methods, the ultimate cosmetic result as judged by blinded observers is no different. 27,28 In addition, less wound inflammatory response has been noted with staples, and they resist infection more effectively than sutures. 26 Studies in animals have suggested, however, that wound tensile strength is actually greater for staples compared with sutures. Despite the remarkable amount of time saved by placing staples instead of sutures, early animal and clinical investigations included questions about the capacity of staples to appose wound edges as accurately or to promote wound tensile strength as effectively as sutures. Since the introduction of automatic skin-stapling devices, there has been a reluctance to use them beyond their intended purpose of closing surgically made incisions. Trott MD, in Wounds and Lacerations (Fourth Edition), 2012 Wound Stapling 139 In a 4-year follow-up the authors reported a further decrease in the ventriculitis rate to 0%. Similarly, in patients requiring placement of an external ventricular drain after a simple infection control protocol ( Table 92.5) reduced ventriculitis rates from 6.3% in the baseline period to 0.8% in the first 3 years of the protocol period. The role of antibiotic impregnated catheters in the new protocol could not be determined. The infection rate was 6.0%, similar to 5.7% with the prior protocol. A total of 1935 procedures were performed on 1670 patients in eight centers revisions constituted 1193 (62%) of these procedures. Antibiotic-impregnated catheters were used for the shunts, unlike the prior protocol. 138 To simplify the protocol, injection of vancomycin and gentamicin into the shunt reservoir was eliminated, as was orientation of the surgical field in respect to the operating room door, placing a sign on the operating room door, or requiring hair clipping rather than shaving. The Hydrocephalus Clinical Research Network has subsequently published results of a revised procedure, with results from January 2012 through September 30, 2013. Only proper hand-washing technique by all team members emerged as an independent predictor of decreased infection rates factors associated with increased infection were use of BioGlide catheters and use of antiseptic cream by any members of the surgical team. 0028), indicating that use of a standardized protocol and reducing variation by adherence to a common protocol are effective at reducing CSF shunt infection rates. The Network infection rate decreased from 8.8% before the protocol to 5.7% while using the protocol (RR reduction, 36% P =. Overall protocol compliance was about 75%, and another 20% followed 10 of the 11 steps. 137 The initiative involved 21 surgeons and included 1571 procedures in 1004 children. 2 The Hydrocephalus Clinical Research Network undertook an initiative in which centers agreed to develop an 11-step protocol to try to reduce CSF shunt infection rates ( Table 92.4) this was a collaboration of pediatric neurosurgical centers and included all children getting shunts or revisions. However, use of “practice bundles” may also be valuable in development of standardized protocols for insertion of CSF shunts. Many of the studies on prevention of CSF shunt infections detailed earlier have examined single interventions to determine effects on infection rates. Bennett MD, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 2020 Combined Interventions
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