Chapter 6: Plastic Surgery. - Famona Site

usually knots more easily and securely. The "memory" in the monofilament material is adisadvantage.Because of their inert nature there is seldom any adverse reaction and themonofilament designs show less tendency for infection.Non-Absorbable Natural ThreadsThe disadvantage fairly consistently quoted is the wick action due to its braided formwhich allows the spread of infection from epithelial surfaces into deeper tissues. It is probablyunwise, with the availability of alternative absorbable materials, to leave silk sutures in deeptissues as they do act as potential foci of infection which can cause complications even longafter healing has stabilized.Clips, Staples and Other Mechanical DevicesThey are very convenient and cost-effective.Adhesive TapesThis is a useful atraumatic way of establishing primary healing where no tension ispresent.Tissue AdhesivesUnfortunately, most substances are toxic or cause foreign-body reactions. The idealis a bio-degradable adhesive with a good tensile strength. The nearest preparation availableis a fibrinogen preparation with its catalyst which is applied to surfaces as for skin grafts oradhesion of large flaps, or for the lower tension aposition of nerves in cable grafts. Whenused for the correct indication, this method has good haemostatic and adhesive properties withgood clinical results. Due to its low tensile strength and expense it is proving slow to gainwidespread application.InstrumentsThe tissue should be so handled as to cause minimum iatrogenic trauma. The mostcommon offenders are forceps and tissue-holding forceps. Fine-toothed forceps arerecommended if used delicately.15