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Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
After the withdrawal of the drain, there is a likelihood of a continued leakage of fluid from the drain site. This can be lessened by the use of a Z-technique when introducing the catheter through the skin and then the peritoneal wall. Some operators tie a purse string suture around the site, some place a stoma bag over the site until the leakage stops, and others have suggested the application of enbucrilate adhesive to seal the skin. Â 76
Perineal skin tear repair following vaginal birth; skin adhesive versus conventional suture – a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Rima Anggrena Dasrilsyah, Aida Kalok, Beng Kwang Ng, Anizah Ali, Kah Teik Chew, Pei Shan Lim
Our study showed that women who had skin adhesive reported significantly less pain at rest as well as during walking and micturition during first week of the postpartum period, in comparison to those who were sutured. Our results are consistent with the findings of previous studies (Adoni and Anteby 1991; Bowen and Selinger 2002). Bowen and Selinger (2002) found that, in women who underwent episiotomy repair, the use of enbucrilate tissue adhesive for skin closure had resulted in less pain on micturition, walking and defaecation when compared to subcuticular Dexon. No significant difference was observed, however, in sedentary activities such as sitting and lying. Study by Adoni and Anteby (1991) showed that Histoacryl was superior to chromic catgut skin suture in episiotomy repair. Women who received skin adhesive had less pain at the episiotomy site and during activity such as walking, micturating and defaecating. Mota et al. (2009), however, found no significant difference in pain, amongst their patients who had perineal skin repair after episiotomy by adhesive glue and suture. In our study, although there were significant reductions in pain scores amongst the adhesive group compared to that of the suture, the mean differences between the two groups were small and may not be clinically relevant in certain situation. For example, the pain scores at rest on day 7 for the adhesive and suture groups were 0.23 and 0.95, respectively. The mean difference of 0.72 may not represent a significant clinical importance, as the average pain score for our cohort was 0.59, suggesting that majority of our women had minimal or no pain at all. First-degree tear is relatively superficial and heals faster than the episiotomy or second-degree tear. Therefore, most of our subjects could have had complete healing by day 7. Nevertheless, the time taken to be pain free was significantly shorter amongst women in the adhesive group in comparison to that of the suture, by an average of 5 days. Bowen and Selinger (2002) reported that women who had skin adhesive in episiotomy repair, reached pain free period quicker than those who had suture (mean = 18 days vs. 25 days; p < .01). Our study found the skin adhesive group had 63% improvement in time taken to be pain free when compared to suture group. Our RCT with follow-up period only involved first-degree tear hence the mean time to be pain free was shorter than that of the episiotomy.