Powder hemostats that offer an alternative solution to ensure haemostasias for wide-surface bleeding comes with numerous advantages compared to other hemostats. Powder hemostats provide a powder-like structure when applied to the bleeding tissue with the help of an applicator, provide bactericidal effect due to low pH properties against various microorganisms, penetrate to the source of bleeding and creates a matrix for thrombocyte adhesion and aggregation. (1, 2)

Powder hemostats manufactured from different raw materials such as oxidized regenerated cellulose with bactericidal properties are used in surgical procedures when ligation or other traditional control methods are impractical or ineffective to help managing the venous and small arterial bleeding. In this article, we will talk about the properties and usage areas of Reoxcel Powder absorbable powder hemostat manufactured from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid) oxidation. (3,4)

Properties and Usage Areas of Reoxcel Powder Hemostats

Reoxcel Powder absorbable hemostats is in powder form in an applicator to easily apply on the bleeding areas and it is absorbed without tissue reaction in the implantation region when applied appropriately at minimum level to the wide-area bleeding region ensuring multi-dimensional compliance. The absorption rate of the Reoxcel Powder absorbable powder hemostat which provides bactericidal effect against 40 types of microorganisms depends on the tissue type, the amount of used powder hemostatic agent and blood saturation level. (1,2,4,5)

What Are The Usage Areas of Powder Hemostats?

Reoxcel Powder absorbable powder hemostat manufactured with ORC oxidation which works independent of the coagulation mechanisms of the body is designed to ensure to stop the parenchymatic organ bleeding and bleeding in recession areas during surgical operations for hemostats in the shortest time. Reoxcel Powder absorbable powder hemostat can be completely absorbed by the body between 7-14 days and can be used for stopping the bleeding when other hemostatic procedures are insufficient. (3,4)

Powder Hemostats Operation Mechanism

Reoxcel Powder absorbable powder hemostat forms a brownish or black gelatinous mass when it comes in contact with blood which aids clot formation. This gelatine-like mass acts as a physical structure for the blood platelet. The bleeding is stopped by blood platelet accumulation and platelet-fibrine plaque formation. (4,5)

Bactericidal Effect Against 40 Types of Microorganisms

Reoxcel Powder absorbable hemostat powder has been proven to have a bactericidal effect in vitro against 40 types of Gr (+) (gram positive) and Gr (-) (gram negative) microorganisms. The table below lists the microorganisms that Reoxcel Powder absorbable powder hemostatic agent provides antibacterial effect. (4, 5)

Pledgets which are known as PTFE mesh are surgical suture accessories that prevent the sutured tissue to be torn. These are manufactured from %100 Polytetrafluoroethylene and the sterilization is completed with EO (Ethylene Oxide). The non-absorbable pledgets are sold in various sizes. (1)

What Are The Surgical Pledget Usage Areas?

Surgical felts that are generally used for patch and sutures by the surgeons are preferred as a support for the larger sections of the left ventricular myocardium to support the fragile tissues. In short, non-absorbable Pledgets (PTFE) provide support to sutured tissue in septal defect, vascular and myocardial repair and prevent the tissue tears. (1,2)

About Boz Teflon Pledgets

The non-absorbable surgical felt (PTFE) launched as Teflon Pledget as a surgical suture accessory is non-woven and has white color. Boz new generation Pledgets (Teflon felt) provide full support to the sutured tissue and are manufactured from 100% Polytetrafluoroethylene. Teflon Pledgets (PTFE) surgical felts manufactured in different sizes to meet the varying procedural needs do not have any known contraindications. (1,2)

Temporary epicardial pace wires also known as TEPW are routinely used in heart surgery since the 1960s. Surgical temporary pace wire are routinely used to ensure hemodynamic stabilization against arrhythmia for adult patients with heart surgery. (1,3,4) These wires are mandatory especially for high-risk patients to repair the atrial septal defect. At the same time, this is the best and sometimes the only method to treat transient arrhythmia.

Temporary epicardial pace wires are commonly preferred in open heart surgeries and especially heart pacer treatments. The value of temporary pace wires for early post-operative arrhythmia diagnosis and treatment is undisputed. (1,2) Hemodynamically significant arrhythmias may occur in early postoperative patients, and temporary epicardial veil wires play an important role in this process. Temporary pace wires can be used in atrial, ventricular, or atrioventricular (AV) form.

What Are The Usage Areas of Temporary Pace Wires?

Temporary epicardial pacing support may be required to resuscitate the heart or regulate rhythm, initially during and after open heart surgery. (4) Temporary epicardial pace wire (TEPW) is routinely applied to open heart surgery patients including coronary artery bypass grafting (CABG) surgery. Temporary heart pace wire is used for electric energy transmission between the external pacemaker unit and the heart of the patient and along itself for transient pacemaker electric control (pacing) and heart EKG monitoring during and after the open heart surgery. For detailed information, see the usage techniques section.

What Are The Things to Be Considered?

It is important to consider that surgical temporary pace wire might lead to rare but important complications, predict which patients and surgeries will need temporary pace wire, investigate the characteristics of these patients and limit the temporary pace wire usage by the surgeon. (2)

Boz Temporary Surgical Temporary Pace Wire

Boz Tempowire temporary pace wire have different sizes as USP 3/0 and 2/0 (metric 2-3) with fixed and double needle, twisted, straight or breakable needle, anchored or non-anchored options. This is a low density PE (LD-PE) coated (insulated) 316LVM surgical stainless steel wire. Tempowire meets all the requirements stated by European Pharmacopoeia (EP) and American Pharmacopoeia (USP) for non-absorbable surgical sutures expect the coating thickness. Additionally, Tempowire can be defined with B&S measurement classification. (5, 6)

Tempowire surgical temporary heart pace wire has one-edge slipped insulation or diameter. It is fastened to myocardium with curved, round suture needle connected to ensure conductivity or fastened with a anchor by passing through the myocardium if it has anchor. The anchor is the stripped and winged piece of insulation close to the curved needle. The other end of the insulated wire is connected to the straight, sharp Keith needle that enables passage from inside to outside from the chest cavity wall to ensure conductivity. Keith needle is equipped with a special notch ensuring frangibility. The sharp part of the surgical needle is broken off from the notch, the part that remains attached to the wire forms the lead pin and connects to conventional pace or monitor equipment.

Tempowire Surgical Temporary Pace Wire Usage

Please check the custom sterile package before opening. If the package is damaged, do not use the pace wire. Please check the instructions regarding opening the sterile package in Figure 2 and 3. The content of the sterile package is sterile (see also Figure 2, indication statement 1). Carefully remove the products in the sterile package. The insulation color on the surgical pacing wire body can be used for identification purpose. Please check Figure 4 for atrial usage (indication statement 1).

Insert the curved needle through the myocardium (see Figure 4) in a direction so that the entry point of the surgical temporary pacing wire into the heart can subsequently align with the exit in the chest. This method might facilitate retraction of the temporary pace wire. It is important to properly position the electrode inside or on the myocardium (see also Figure 5).

Atrial Usage: Position the electrode inside the myocardium. This is ensure by slightly pulling the curved needle while pulling the wire inside the tissue.

Cut the wire removed from the myocardium and curved needle until the rest of it stays in the myocardium (see also Figure 6). During the high displacement risk period, the cutting procedure might not be applied immediately because the wire is cut after a short period. Discard the myocardial curved needle.

Hold the chest needle distally from the separation mark (see Figure 7) and insert it through the chest wall in a direction that will allow the pacing wire in the heart to align with the chest exit. Keep some part of the conductive wire inside the check to prevent any displacement due to patient movement. Using a needle driver for this procedure is recommended.

Break the chest needle from separation mark (see also Figure 8). Discard the chest needle.

Connect the wire connector pins to the external pulse generator, patient cable, or surgical cable, following the polarity below. Connect the pin to the negative pole (-). The neutral wires must be connected to the positive pole (+) of the external pulse generator.

When the surgical wire is no longer needed, carefully pull to remove the wire.

Surgical sutures which are also called the sutures are among the most preferred medical devices among other medical materials used for closing and sewing wounds (wound closure elements). Surgical sutures, whose discovery and usage date back 4000 years, have come a long way from the past to the present. With modern medicine, many different types of surgical sutures have been produced. Surgical sutures can be natural, synthetic, absorbable, unabsorbable, antibacterial, multifilament or monofilament options.

What Are Natural Surgical Sutures And What Are Their Types?

There are 2 different types when the surgical sutures are divided according to raw materials. These are natural surgical sutures and synthetic surgical sutures. The natural surgical sutures are divided into two categories. These are plant-based surgical sutures and animal product-based surgical sutures. The surgical sutures manufactured with these two raw materials from the nature can be categories as natural surgical sutures.

Plant-Based Surgical Sutures

Silk, which is the most widely used surgical suture today, is a sterile surgical suture consisting of non-absorbable organic polymer called fibroin. It is obtained from natural protein filaments derived from Bombyx Mori silkworm cocoon. (1, 2) Before the silk surgical suture is manufactured in the braided format, one of the 2 protein substances inside and the adhesive part are processed with wax and hum in the silk to be removed. This process gives a tighter knitting structure that significantly improves the quality of the braided and non-absorbable surgical suture produced from natural silk. After knitting, it is cooked and then coated with paraffin wax and silicone. (1, 2, 3)

Natural silk surgical sutures are the most preferred suture options around the world due to their softness, flexibility, thinness, ease of use and bonding properties. Due to its multi-filament (braided) structure, it has high capillary properties and requires very few nodes in terms of node safety. Surgical natural silk sutures are used for soft tissue closure or binding, including cardiovascular, ophthalmic and neurosurgery applications. (1.2)

Animal-Based Surgical Sutures

This is an absorbable natural products called catgut which was named from a violin called “Kit” by the ancient Egyptians Arabs and it is referred as a surgical gut. During the production of this surgical suture which includes the submucous porous tissue of the sheep’s intestine or the serosa membrane of the cows, the parts of the connective tissue, which are cleaned with special care and whose oil is taken, are reconstituted, twisted and dried until the desired thickness is reached. (1, 4, 5)

In addition to the normal use of catgut sutures, it is treated with the necessary chrome salt solutions for the purpose of extending the absorption time. For this reason, the catgut surgical sutures are divided into normal catgut and chromium catgut in the medical field. (1,4,5)

What Are the Synthetic Surgical Sutures and Their Types?

Synthetic raw materials, which do not occur naturally and are created by human efforts, are used in the production of many medical devices in today’s health field. Synthetic raw materials, which provide many advantages especially in the production of surgical suture, have greatly contributed to the development of surgical sutures.

The types of synthetic surgical sutures used today are divided into different categories which are monofilament (straight) and multifilament (braided) as well as absorbable and non-absorbable. Synthetic surgical suture types with different chemical structures provide ease of use in many surgical branches, as well as low reaction and high strength in the tissue. (18,19)

Polyglycolic Acid (PGA) Surgical Sutures

This type which is a homo-polymer of glycolic acid, is the first synthetic, absorbable surgical suture and was first introduced in 1970. This type of suture with synthetic structure has delayed absorption and reduced tissue reaction compared to catgut sutures, as well as good tensile and better knot strength. Similar to chromic catgut, it shows absorption and polyester (PET)-like strength and knot safety.

Made from polyglycolic acid, these synthetic and absorbable surgical sutures have a multifilament structure and can also be coated with polycaprolactone, a synthetic coating to ensure smooth tissue transition and seamless knot bonding. (1,6,7)

Poly Glycolide Lactide Acid (PGLA) Surgical Sutures

Poly glycolide lactide acid (PGLA) which is another type of absorbable synthetic surgical suture is flexible, absorbable and poly [%90 glycolide + 10% lactide] (glycolic and lactide acid derivative), which can be absorbed when used in living organisms and does not cause excessive irritation in tissue. Striped variations of surgical sutures whose chemical structure is Poli Glycolide Lactide acid (PGLA) use Poli (Glycolide Lactide) (30/70) and calcium stearate as special coating agent. (20)

Poly Glycolide Caprolactone (PGCL) Surgical Sutures

Polyglycolidcocaprolacton PGCL, a synthetic type of surgical suture synthesized from caprolactone and found in a monofilament structure, provides high node safety in closing superficial wounds such as sterile surgical filament dental operations and does not cause excessive tissue irritation throughout absorption. (9)

Produced in two different colors, colorless and purple (violet), EO (ethylene oxide) sterilized and chemically manufactured from 75% Glycolide and 25% co-caprolactone, synthetic and absorbable PGCL surgical sutures provide 45%-70% tissue support in the first week and are completely absorbed by the body within 90-120 days. (8, 9)

Polydioxanone (PDO) Surgical Sutures

Manufactured from polydioxanone poly (p-dioxanone) polyesters, Polydioxanone (PDO) has a monofilament structure and is a type of synthetic sterile surgical suture. Polydioxanone polymer has a nonantigenic and nonpyrogenic structure. The empirical molecular formula of the polymer is (C₄H₆O₃)x and polydioxanone surgical sutures can cause light tissue reaction during absorption by the body. (10)

To ensure visibility in surgical operations, Polydioxanone (PDO) absorbable surgical sutures are purple (violet) colored and sterilized with EO (ethylene oxide) and used including ophthalmic applications and pediatric cardiovascular tissue where growth is expected to occur. Synthetic and absorbable PDO surgical sutures with chemical structure of 100% Polydioxanone provides 70% tissue support in 2 weeks and is fully absorbed by the body within 180-240 days. (10, 11)

Polypropylene (PP) Surgical Sutures

Manufactured from the stereoisomer of the isotactic crystal of polypropylene, the chemical structure of polypropylene (PP), a type of synthetic surgical suture with monofilament structure that is usually produced in blue or black to enhance its appearance during surgical intervention. Further, it is synthetic linear polyolefin, consisting of the stereoisomer of the isotactic crystal of polypropylene. (12)

Polypropylene sutures that used in general soft tissue closure and binding, including cardiovascular, ophthalmic and neurosurgery applications, are often used in general surgery, soft tissue approximation and ligation, fascia stitching, patch detection and skin closure (both individually and subcuticular). It is used in almost all surgical areas, including cardiovascular, orthopedic, eye, microsurgery and neurological surgery. It is the type of surgical suture used in the vascular suturing the anastomoses due to its slippery and elastic structure. (13, 14)

Polyamide (PA) Surgical Sutures

Non-absorbable and sterile Polyamide (PA) surgical sutures which are the first synthetic surgical strand are manufactured in two different type as monofilament and multifilament consisting of long-chain chains of aliphatic polymer chemically known as nylon 6 or nylon 6.6 come in black or blue color to increase visibility in the tissue. (1, 15)

Known for its high tensile strength, excellent elastic properties and minimal tissue reaction, polyamide (PA) non-absorbable surgical sutures are used in general soft tissue closure and binding, including cardiovascular, ophthalmic and neurosurgery applications. (1, 15)

Polyvinyl Difluoride (PVDF) Surgical Sutures

Known as polyvinyl fluoride or polyvinyl difluoride (PVDF), it is a non-reactive thermoplastic produced by polymerization of vinylene difluoride. Sterile, non-absorbable PVDF surgical sutures consisting of polyvinyl difluoride polymer has monofilament structure and dyed blue and black to increase visibility. (16, 17)

In addition to its strong and flexible structure, the surgical suture sterilized with EO (ethylene oxide) is resistant to infection. It is successfully used in infected or contaminated wounds to minimize or eliminate subsequent sinus formation and excretion of the suture. (16, 17)

Polytetrafluoroethylene (PTFE) Surgical Sutures

Non-absorbable, monofilament and synthetic surgical sutures made of 100% Polytetrafluoroethylene are produced from high density 100% polytetrafluoroethylene by pulling to maintain integrity and tensile strength, as well as to produce a structure with a minimum pore size and volume.

Polytetrafluoroethylene (PTFE) surgical sutures are often preferred in cardiovascular surgery, dental treatment and eye surgery, show excellent biocompatibility, provide high knot strength and have an extremely low friction coefficient. (21, 22)

Polyester (PET) Surgical Sutures

Polyester (PET) surgical sutures made of long-chain linear polyester, with high molecular weight and composed of Polysyl Poly (ethylene terephthalate) are multifilament and synthetic surgical sutures. The surgical suture with Polyester (PET) comes with either coated or uncoated silicone elastomer form. The coating material, which has high adhesive strength in the tissue, is not reactive and is sterilized with EO (Ethylene oxide).

The non-absorbable coating provides permanent tissue support and acts as a lubricant. This property enables the synthetic structure to easily pass from the tissue as well as ease-of-use. Polyester (PET) synthetic non-absorbable surgical sutures are often used to seal and bind general soft tissues, including cardiovascular, ophthalmic and neurosurgery applications. (23)

Hernia is a common pathology type in the community. Hernia is weakened muscle or formation holding the internal organs to droop/shift from the organ to another place it is not supposed to be and being located in another area. There are numerous hernia types. In this article, we will talk about hernia types, hernia treatment methods and the importance of using surgical mesh in hernia repair.

What Does Hernia Mean?

The word comes from the Latin language and it is used in the English language since 1350-1400. The term is known as “herni” or “fıtık” in the Turkish language and the word comes from Arabic just like the word “surgeon”. The term is also known as rupture in the English language. The term will be used in English or Latin form in the text depending on the context. (3)

Hernia Repair Methods from Past to Present

The first written sources about hernia disease and treatment methods date back to ancient times. Ebers Medical Papyrus written in 1550 BC on Egyptian papyrus is accepted as the first document dating back to Hammurabi period. (3)

Hernia Treatment in Ancient Times

Hernia ties that is used as a temporary hernia treatment solution during the Phoenician period in the ancient ages helped individuals to continue their daily lives without any problem. (See also: Image 1) Again, another method used in the same period as a permanent solution for hernia was turning the inguinal hernia by applying pressure on the cramped organ to turn the muscle back to its position which is called reduction (replacement) method today. (See also: Image 2). (3,4,5,6)

Hernia Treatment in Hippocrates Period

The information related to hernia treatment in “Surgical Treatment of Inguinal and Femoral Hernia” book of one of the important surgeons and medical painter Prof. Dr Demir A. Uğur whose early death was a great loss for the Turkish surgery is based on the Hippocrates period. Praxagoras (335 BC), the medical school surgeons of Alexandria and Caelius Auretanius (350 BC) mentioned special treatments of strangled hernia. (3,7)

Celcus (25BC – 50 AD) who is one of the Roman medical representatives but not a doctor wrote the following about the surgical treatment of hernia:

“An incision is made to the groin or scrotum, the hernia sack is separated from the cordon structure and pushed back inside the ventral cavity. The hernia sack is removed. The bleeding veins are tied with plant-based sutures. Vinegar is poured on the surgical wound for cicatrisation.”

Hernia Treatment in Turkish Surgical History

The first Turkish surgical book was written in 1465 by Şerafettin Sabuncu of Amasya and he mentioned hernia treatment in his book. (3)

Milestone in Hernia Anatomy and Surgery

The most important developments in hernia anatomy and surgery emerged at the end of the 18th century and the beginning of the 19th century. Gimbernat (1793), Camper (1793), Cooper (1804) and Scarpa (1806) announced a new era in hernia treatment with their works on inguinal anatomy. The desired results were achieved in hernia surgery with the successful surgical technique applied by Italian surgeon Edoardo Bassini in 1886. (3)

Hernia Anatomy and Surgery in the 20th Century

The 20th century marked the history with important steps in the modern surgery. The important developments in the hernia anatomy and surgery started to give more positive results in 1950s especially with surgical mesh usage in inguinal hernia treatment. Surgical mesh usage that became widespread since 1980s are common today as well. Successful results are achieved in hernia surgery especially with endoscopic/laparoscopic repair methods that started to be applied especially in 1990s. (3)

How Is Hernia Diagnosed?

The abdominal hernia in the abdominal or groin area are noticed with lumps that can either come with pain or be painless. The pain occurs when a part of the small intestine bulges outside as the abdominal muscle holding the internal organs rupture. More interestingly, it is possible to push the small intestine back by hand in some of the patients who experience bulging and retreating hernia. (4,5,6)

The hernia on the spine are not visible. The main complaints of patients with neck and back hernia are pain around back and neck, limited mobility and inability to turn. The location, level and number of hernia can be easily identified in radiologic imaging tools such as MR and the surgeon can decide on the treatment method. Physical treatment or surgical intervention is followed depending on the hernia. (5,6)

Hernia Prevalence Among Men and Women

Hernia is more prevalent among men than women. The hernia prevalence for men is 27% while this ratio is 3% for women. Inguinal hernia is 4-5 times more common in men than women. The reason for low prevalence among women is that women have wider and larger pelvis which causes the hernia triangle including the rectus muscle, inguinal ligament and transverse aponeurotic arcus to be narrower. (12)

What Are Hernia Types?

Hernia is mostly seen in abdominal region and spine (back or neck) region. Hernia commonly occurs around groin area and the hernia around the groin can be divided into two. The first one is called inguinal hernia which occurs naturally on its own. The second one is the incisional hernia which occurs due to an external intervention. (9,10)

Inguinal Hernia

This hernia occurs naturally and the main reason is the bulged internal organs due to weakened peryton which is the lowest layer of the abdominal muscle. The patient can go back to normal life without any pain after repairing the weak or ruptured peryton with surgical intervention and by using surgical mesh as an artificial wall. (8,9)

These hernia called the inguinal hernia is divided into three as direct, indirect and femoral hernia. Direct hernia is the bulged hernia due to weak or ruptured peryton which is the lowest layer of the abdominal muscle and this hernia is visible. The indirect hernia is invisible from the outside and the hernia occurs around the testicle and testicle sacks. Femoral hernia is generally seen in women and this is a visible bulge around the lower part of the groin which is around the artery on the femur. (8,9,11)

Incisional Hernia

These are hernia that occur after any abdominal surgery. These are often called interventional hernia. Approximately 10-15 of every 100 abdominal surgical operations leads to incisional hernia problem. The reason for such problem to occur in operated individuals is the insufficient surgical technique or post-op operation or factors to prevent wound healing (obesity, diabetes, cortisone use or other chronic diseases). Similarly, these problems can be repaired with surgical mesh by patching up the abdominal area with hernia. (9,10)

What Are The Most Common Hernia Repair Methods?

Hernia repair and especially inguinal hernia repair is performed depending on the hernia status and to decrease the recurrence rate. Numerous hernia repair methods are used from past to present. Today, various methods are preferred by the surgeons for hernia repair as synthetic surgical mesh materials are more common. (12,13,14)

Rutkow & Robins Method

This method first applied in 1912 by the Italian surgeon Davide Fieschi (1869-1963) is repairing the femoral hernia by using a plug mesh. This treatment method was highly popular in the 90s and plugs with various size and shapes were used in hernia repair. These plugs were commonly used for direct and indirect open inguinal hernia repair as well as umbilical hernia repair. This method was spread by two American surgeons Rutkow and Robins who named the method. This three dimensional material that acted as both a plug and mesh in hernia repair was replaced by straight synthetic absorbable, non-absorbable or semi-absorbable surgical mesh with ideal pore range. (16,17)

Why Is Plug Method No Longer Preferred in Hernia Repair?

So, why Rutkow & Robins method which is a plug-mesh technique n longer popular for hernia repair? To give a simple answer, there were problems with the plugs. The plugs placed around the hernia region shrunk, lost their volume and caused hernia relapse. The plugs caused chronic pain by mechanically interacting with the nerves around the tissue. The plugs moved from their initial position to other tissues. They caused masses called meshomes. However, this hernia repair method is still popular in some countries like Japan. (16)

Lichtenstein Method

The abdominal hernia is repaired with open or closed procedure in modern hernia surgery. Closed (laparoscopic) methods use small holes instead of incisions to repair with a mesh. The open repair technique called Lichtenstein technique which is known as the classic method is commonly used and brings important advantages to patients. In Lichtenstein hernia repair technique, a long and thin incision is made across the tissue in the size of the hernia, the rupture in the abdominal wall is reached, the bulged internal organ is pushed inside and the mesh is placed on the ruptured abdominal wall behind the muscles depending on the hernia diameter. Another mesh is placed behind the facia which is a strong layer and on top of the muscle layer and lastly, the mash is sutured without causing a tension and the incision is closed. Thus, the abdominal wall is strengthened from inside to prevent any rupture with pressure and hernia relapse is low. (14,15,17,18,19)

Lichtenstein repair is the most commonly used method among the open mesh placement methods and this method is accepted as the golden standard for inguinal hernia repair by the American College of Surgeons. The purpose of this hernia repair technique is to repair the hernia with a comfortable and safe method and to make sure the patient goes back to normal time in the shortest time possible. (14,15,18)

Bibliography

(1) Fıtık, herni nedir? Çeşitleri | turkcerrahi.com. (2022, February 02). Access address: https://www.turkcerrahi.com/tip-sozlugu/fitik

(2) Hiatal Herni Nedir? | turkcerrahi.com. (2022, February 02). Access address: https://www.turkcerrahi.com/tip-sozlugu/hiatal-herni

(3) Fıtık kelimesi nereden geliyor? – Fıtık Akademisi. (2022, February 02). Access address: http://fitikakademisi.org/fitik-kelimesi-nereden-geliyor

(4) Kasık fıtığının redüksiyonu (yerine konması) ne demektir? (2015, November 17). Access address: https://cocuklardafitik.wordpress.com/2015/11/17/kasik-fitiginin-reduksiyonu-yerine-konmasi-ne-demektir

(5) izmir | Kasık Fıtığı – İnguinal Herni | Doç. Dr. Erdal TÜRK | Çocuk Cerrahisi Uzmanı. (2016, April 19). Access address: https://www.erdalturk.com.tr/hastaliklar/kasik-fitigi.html

(6) Anirudhan, A. (2008). A prospective analysis comparing stoppa’s repair with conventional repair in complex bilateral and recurrent inguinal hernias (Doctoral dissertation, Madras Medical College, Chennai).

(7) Prof. Dr. DEMİR A. UĞUR, İnguinal ve Femoral Fıtıkların Cerrahi Tedavisi (Ankara: Ankara Üniversitesi Tıp Fakültesi. 1980)

(8) abdominal muscle | Description, Functions, & Facts. (2022, February 03). Access address: https://www.britannica.com/science/abdominal-muscle

(9) Kasık (İnguinal) Fıtıkları (Hernileri) – Genel Cerrahi – CENTRAL HOSPITAL. (2022, February 03). Access address: http://centralhospital.com/TibbiBolumler/genel-cerrahi/yontem/kasik–inguinal–fitiklari–hernileri-

(10) insizyonel Herni – Fıtık Akademisi. (2022, February 03). Access address: https://fitikakademisi.org/insizyonel-herni

Bibliography – Part 2

(11) Femoral Herni – Fıtık Akademisi. (2022, February 03). Access address: https://fitikakademisi.org/femoral-herni

(12) Dr. Güney Özkaya “Kasık Fıtıklarında Laparoskopik Yöntemler Ve Sonuçları” İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Genel Cerrahi Anabilim Dalı, İstanbul (2020):14

(13) Ok E, Küçük C, Akcan A, Sözüer E, Yılmaz Z “Mesh-Tıkaç Sütürsüz Gerilimsiz Onarım Yönteminin Lichtenstein ve Mc Vay Doku Onarım Yöntemiyle Karşılaştırılması” Erciyes Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, Kayseri, Ulusal Cerrahi Dergisi (May 2002) Volume 18, Number 3, Page 153-159

(14) Ocakoğlu A “Lichtenstein Yöntemi (Prolen Yama Tekniği) ile Kasık Fıtığı Tamiri” 2011;22(2):57-59

(15) Kasık Fıtığı Ameliyatları – Fıtık Akademisi. (2022, February 04). Access address: https://fitikakademisi.org/kasik-fitigi-ameliyatlari

(16) Plug-Tıkaç Yama Tarihe Karıştı! – Kasık-Göbek-Ameliyat Fıtığı Tedavisi | Fıtık Cerrahisi | Fıtık İstanbul. (2022, February 04). Access address: https://fitikistanbul.com/plug-tikac-yama-tarihe-karisti

(17) Cerrahi Mesh (Yama) Nedir ve Kullanım Alanları Nerelerdir? – Boz Tıbbi. (2022, February 04). Access address: https://www.boztibbi.com/bilgi/cerrahi-mesh-yama-nedir-ve-kullanim-alanlari-nerelerdir

(18) Fıtık Cerrahisi | Kasık Fıtığı Ameliyatları. (2022, February 04). Access address: http://fitikcerrahisi.org/kasik-fitigi-ameliyatlari

(19) Koçer, Dr. H. (2022, February 04). Açık Yöntem. Access address: https://www.fitik.com.tr/acik-yontem

Visual Bibliography

Rutkow plug repair in inguinal hernia – general and visceral surgery – webop. (2022, April 05). Access address: https://www.webop.com/general-and-visceral-surgery/Hernia-surgery/Rutkow-plug-repair-in-inguinal-hernia

Lichtenstein Repair of Inguinal Hernia – general and visceral surgery – webop. (2022, April 05). Access address: https://www.webop.com/general-and-visceral-surgery/Hernia-surgery/Lichtenstein-Repair-of-Inguinal-Hernia

Hemostats also known as antihemorrhagic agents are hemostatic agents used on the bleeding region to stop the bleeding on a tissue or organ. The process to stop the bleeding is called haemostasias. The bleeding will stop on its own in individuals without any hemostasis mechanism disorders as inflammation stage by blood clothing. (1,13.14) When the body is insufficient to stop major or minor bleeding because of internal or external wounding due to external intervention, tearing, rupture, traumatic cuts, dental operations, surgical or spontaneous interventions, surgical intervention is performed and hemostatic agents must be used. (21) In this article, we will look into hemostats which are antihemorrhagic or hemostatic agents.

What Is Hemostasis?

Stopping the bleeding caused by tissue wounding, tearing or rupture due to trauma or surgical intervention is called hemostasis. When the tissue is cut and the bleeding starts, the defense mechanism will be activated as soon as the blood contacts with the air. The end of the cut vessels will contract at first. Then, there will be clothing at these ends and the coagulation will expand to block the vessel and stop the bleeding. The hemostasis state refers to blood coagulation and stopping the bleeding as a result of the relationship between natural-biologic or artificial-human intervention thrombocyte and coagulation factor. (1,7,11,13)

What Are The Usage Areas of Antihemorrhagic Hemostatic Agents?

In general, antihemorrhagic hemostatic agents are used for stopping both internal and external major or minor bleeding due to injuries, cuts, tearing, ruptures, traumatic cuts, dental operations, surgical or spontaneous interventions. (15)

What Are Hemostat (Antihemorrhagic Agent) Types?

The main hemostatic agents when we talk about hemostats are cellulosic or collagen-based agents. Also, there are antihemorrhagic agents with fibrine materials, synthetic adhesives or hemostatic powder or hemostatic matrix. Today, hemostatic agents produced from oxide cellulose are often preferred for minor bleeding. Cellulose hemostats produced in Boz Medical comply with “Oxidated Regenerated Cellulose” and “Oxidates Cellulose” standards of USP American Pharmacopeia. (1,3,15,21)

What Are Cellulose-Based Hemostatic?

This hemostatic agent which is the most preferred antihemorrhagic agent produced from oxidized cellulose was first developed as to act as a buffer for the bleeding tissue. This cellulose-based antihemorrhagic agent designed to induce the tissue for coagulation should only be used for the local management of minor bleeding. (1,3,4)

What Is Microfibril Collagen?

These are antihemorrhagic agent types developed in 1970 from bovine hide raw material to create hemostatic effect by applying on irregular surfaces in the bleeding region. This is a white, soft-looking, dry powder. (1,5)

What Is Anastomotic Adhesive?

Anastomotic adhesives that are used as hemostatic for surgical operations and trauma are divided into three as gelatin, thrombin and fibrinogen agents.

Hemostatic Agents With Bovine Gelatin and Human Thrombin

Collagen which is the building block protein type for the bovine or swine movement system is used for gelatin production. (16) Thrombin is coded by F2 gene in humans to trigger coagulation and created with thromboplastic effect from prothrombin in hemostasis. (7) This is locally applied to tissue surface for bleeding due to capillary damage. (6) The gelatin particles consisting of collagen and human derivative thrombin will expand when contacted with blood, absorb the blood 40 times more and can reach 200% times more that the initial size. These hemostatic agents are in sponge, solution or powder form.

Hemostatic Agents with Fibrinogen

Fibrinogen is an important protein produced by the body for the coagulation process. This is a protein type known as proto-coagulator and activates when any tissue in human body is damaged. Hemostatic agents with fibrinogen are combined with human derivative thrombin to turn into a stable fibrin. The existing thrombin levels around the wound region and fibrinogen levels determine the coagulation speed. (6,18)

What Is Synthetic Adhesive?

An adhesive type produced from bovine albumin and glutaraldehyde is applied to the bleeding wound for a flexible and practical sealing with this hemostasis method that is independent of the coagulation mechanism of the body. Glutaraldehyde molecules and bovine albumin molecules have covalent bound. (1)

What Is Micro Porous Polysaccharide Hemosphere?

Micro porous polysaccharide hemosphere (MPH) is plant-based and accelerates coagulation in contact. This is a fluid hemostatic powder designed for fast blood dehydration. After applying the powder on the bleeding surface, the osmotic effect of the dissolved materials inside the cell will expand the powder particles and increases the density of serum protein, thrombocyte or blood-platelet and other elements on the tissue. It creates the skeleton for fibrin coagulation as the hemostatic powder and tightened cells are coated. The hemostatic powder on the tissue is completely absorbed in 24-48 hours and the powder is enzymatically cleaned from the wound on the tissue or organ. (1,17)

What Are Chitin and Chitosan-Based Hemostatic Agents?

Chitin is one of the most important and second most common amino polysaccharide in the nature which is a type of carbohydrate used by arthropods such as crab and shrimp to dry the outer skeleton and by mushrooms to form the cellular wall. (8,10,19) While there are various chitin types, the most important one is chitosan. Chitosan was produced in 1894 by Hoppe-Seyler by processing chitin inside potassium hydroxide at 180°C (deacetylation) and chitosan was produced with decreased acetyl content. The data from the animals showed that hemostats containing chitosan acetate as an active ingredient decreased bleeding. Today, chitosan has an important place in the medical field and it is used as a raw material for antihemorrhagic agent hemostatic material production and animal and human band aid product as this material accelerates the wound healing by 30%.

What Is Zeolite Antihemorrhagic Agent?

Zeolite is a natural mineral in the nature and absorbs the water on the damaged tissue with exothermic reaction. Therefore, this material increases blood platelet density by breaking down the matured cells in coagulation factor and bone marrow to induce coagulation. (1,17)

Additionally, this material has FDA approval only for external bleeding. This is because 95% local temperature on tissue surfaces of animal models. As a result, there is need for more research since this material is dangerous for internal bleeding by considering the partial damage the material causes for external application. (1,20)

What Are Hemostats Similar to Ankaferd?

Ankaferd antihemorrhagic hemostatic agents are used as hemostats in Anatolia for centuries in alternative medicine field. These hemostats used for stopping the external bleeding are a plant-based mixtures used as a first-aid material rather than for medical operations. This is a hemostatic antihemorrhagic agent with two types which are spray and cream. (1,2,12)

What Are Absorbable Hemostats of Boz Medical?

As Boz Medical, we have 3 types of sterile hemostats which are plain textile, fibred or powder produced from alpha-grade cotton, Oxidized Regenerated Cellulose (ORC) and Oxidized Cellulose (OC) raw materials. (15)

Reoxcel (ORC)

Reoxcel absorbable hemostatic is a sterile hemostatic (antihemorrhagic) preparate produced from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid) and has antibacterial effect against 40 types of microorganisms. Reoxcel hemostatic agent has plain textile structure, ensures coagulation in 3-4 minutes and completely absorbed by the tissue in 7-14 days. Reoxcel hemostatic agent complies with “Oxidized Regenerated Cellulose” standards of USP American Pharmacopeia.

Reoxcel Fibril

Reoxcel Fibril absorbable hemostatic is a sterile hemostatic (antihemorrhagic) preparate produced from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid) and has antibacterial effect against 40 types of microorganisms. Reoxcel hemostatic agent has fibred textile structure, ensures coagulation in 3-4 minutes, completely absorbed by the tissue in 7-14 days and does not show tissue reaction at implant region during absorption. Reoxcel Fibril hemostatic agent complies with “Oxidized Regenerated Cellulose” standards of USP American Pharmacopeia.

Reoxcel Sigma Knit

Reoxcel Sigma Knit absorbable hemostatic agent has plain textile structure and manufactured from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid). Reoxcel Sigma Knit ensures coagulation in 3-4 minutes, completely absorbed by the tissue in 7-14 days without tissue reaction and shows antibacterial effect against 40 types of microorganisms. Reoxcel Sigma Knit hemostatic agent complies with “Oxidized Regenerated Cellulose” standards of USP American Pharmacopeia.

Reoxcel Snow

Reoxcel Snow absorbable hemostatic agent is a sterile hemostatic (antihemorrhagic) preparate produced from non-woven material structured from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid) and has antibacterial effect against 40 types of microorganisms. Reoxcel Snow hemostatic agent has cotton-like plain textile structure for better compliance and connectivity with the hemorrhage regions, ensures coagulation in 3-4 minutes with uniquely structured fibers and do not stich to medical tools with ease-of-use. This is completely absorbed by the tissue in 7-14 days. Reoxcel Snow absorbable hemostatic agent complies with “Oxidized Regenerated Cellulose” standards of USP American Pharmacopeia.

Reoxcel Powder

Reoxcel Powder absorbable powder antihemorrhagic agent is manufactured from oxidized regenerated cellulose (ORC) (polyanhydride glucuronic acid). Venous, capillary and minor artery hemorrhage are controlled with ORC technology. Reoxcel Powder is an absorbable powder hemostatic agent and this agent effectively and efficiently controls the leakage on large tissue surface. Reoxcel Powder works fast to stop the bleeding and provides the necessary surface to initiate coagulation with blood platelet adhesion and aggregation when contacted with blood. Durable coagulation to gold the hemostasis is formed during irrigation.

Zeocel (OC)

Zeocel absorbable hemostatic agent is a sterile hemostatic agent manufactured from alpha-degree cotton in oxidized cellulose (OC) (polioxidhydro glucuronic acid) form. There will be coagulation in 3-4 minutes after application, absorbed in 7-14 days without any tissue reaction and shows antibacterial effect against 40 types of microorganisms. Zeocel hemostatic agent complies with “Oxidized Cellulose” standards of USP American Pharmacopeia.

Where Are Boz Medical Hemostats Used?

Absorbable antihemorrhagic hemostatic agents manufactured by Boz Medical can be used in general surgery, digestive system surgery, neurosurgery (especially brain operations), plastic surgery, orthopedics, gynecology, urology, stomatology, throat and nose surgeries, traumatology and cardiovascular surgery, vascular prosthesis implantation, facial and maxillofacial surgery, lung operations, hemorrhoidectomy, biopsies, liver and biliary operations, gastric resection, thoracic and abdominal sympathectomy as well as other surgical fields. Boz Medical absorbable hemostats can be applied to cavities (after tumor removal) as well as endoscopic operations and dental procedures.

Bibliography

(1) Çolak S, Altan A, Akbulut N, Lokal hemostatik ajanlar. Journal of International Dental Sciences 2018; 3: 147-152.

(2) Günay C, Sağlıyan A, Durmuş Ali S.,Mokhtare B, Köm M,  Ratlarda Ankaferd Blood Stopper’ın Hemostatik ve Doku İyileşmesi Üzerindeki Etkilerinin Değerlendirilmesi. Fırat Üniversitesi Sağlık Bilimleri Dergisi 2021; 35 (1): 13 – 19

(3) Recinos G, Inaba K, Dubose J, Demetriades D, Rhee P. Local and systemic hemostatics intrauma: A review. Travmada lokal ve sistemik hemostatik ajanlar: Derleme yazısı. Ulus Travma Acil Cerrahi Dergisi;14(3):175-181

(4) Paparo F, Denegri A, Revelli M, Puppo C, Garello I, Bacigalupo L, Garlaschi A, Rollandi L, Fornaro R, Crohn’s disease: Value of diagnostic imaging in the evaluation of anastomotic recurrence. Ann Ital Chir 2014;85(3):271-281

(5) Karahaliloğlu Z, Nanoteknolojik yaklaşımlarla koagülatif sistemlerin geliştirilmesi. (Tez Çalışması) Hacettepe Üniversitesi 2015;24(2.3.2.3.)

(6) Atalan N, Hemostatik İlaçlar GKDA Dergisi 20(1):1-6, 2014. Access address: https://jag.journalagent.com/gkdaybd/pdfs/GKDAYBD_20_1_1_6.pdf

(7) Dr. Meriç G, Omurga Cerrahisinde Kullanılan Hemostatik Ajanların Nöral Dokular Üzerindeki Etkilerinin Karşılaştırılması (Canlı Sıçan Denekler Üzerinde Yapılan Histoloji Çalışması) İzmir Dokuz Eylül Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı – 2010 Access address: https://acikerisim.deu.edu.tr/xmlui/bitstream/handle/20.500.12397/13289/267051.pdf?sequence=1&isAllowed=y

(8) Özdemir Z, Kitin; kitosanın fonksiyonel özellikleri ve kullanım alanları. Türkiye Kimya Derneği 2014;104-111.

(9) Doğa Elçi S. Kitosan Türevlerini İçeren Hidrojellerin ve Çözeltilerin Hemostatik Özelliklerinin Değerlendirilmesi. Hacettepe Üniversitesi Lisansüstü Eğitim – Öğretim ve Sınav Yönetmeliğinin Biyoloji Anabilimdalı İçin Öngördüğü Doktora Tezi olarak hazırlanmıştır. 2019. Access address: http://www.openaccess.hacettepe.edu.tr:8080/xmlui/handle/11655/9344

(10) Demir A, Seventekin N, Kitin, Kitosan ve Genel Kullanım Alanları. Tekstil Teknolojileri Elektronik Dergisi Cilt: 3, No: 2, 2009 (92-103)

(11) Prof. Dr. Altundoğan S, Kanama Kontrolü. (January 2022) Obtained from:  https://acikders.ankara.edu.tr/mod/resource/view.php?id=56394

(12) Beyazıt Y, Kurt M, Kekilli M, Göker H, Haznedaroğlu İC, Evaluation of hemostatic effects of Ankaferd as an alternative medicine. 2010;15(4):329-336

(13) Hemostaz – Hemostaz Nedir? (t.y.). https://www.turkcerrahi.com/ adresinden Ocak 2022 tarihinde elde edildi.

(14) Yaralar nasıl geçer? (t.y.). Obtained from https://www.sabah.com.tr/

(15) Hemostats (2019). Boz Medical. Access address: https://www.boztibbi.com/en/products/hemostats/

(16) Kolajen Nedir? (2021) Access address: https://www.medicalpark.com.tr/kolajen/hg-2367

(17) Trombosit (Aralık 2020). Obtained from: https://www.acibadem.com.tr/ilgi-alani/trombosit/

(18) Fibrinojen nedir? Fibrinojen değeri kaç olmalıdır? Düşüklüğü ile yüksekliği nedenleri ve belirtileri (2020) Access address: https://www.hurriyet.com.tr/aile/fibrinojen-nedir-fibrinojen-degeri-kac-olmalidir-dusuklugu-ile-yuksekligi-nedenleri-ve-belirtileri-41539958

(19) Kitin (November 2020). Access address: https://tr.wikipedia.org/wiki/Kitin

(20) Kitosan (December 2021) Obtained from:  https://tr.wikipedia.org/wiki/Kitosan

(21) Kategori:Hemostatik ajanlar (2021) Wikipedia. Access address: https://tr.wikipedia.org/wiki/Kategori:Hemostatik_ajanlar

These medical devices or medical materials called surgical mesh or surgery mesh are used for hernia repair for weak tissues and to act as artificial reconstructive materials in damaged tissues such as the groin region which are applied as a layer. The surgical meshes that are used in the operation can be made from the patient’s own tissues as well as from cadaver or animal depending on the surgical operation and operation conditions. Today, synthetic surgical meshes are generally preferred. (1)

What Are The Surgical Mesh Usage Areas?

The surgical mesh use has become a standard procedure for inguinal hernia around the world. These surgical meshes are used in hernia treatment as a mesh and it is discovered that the implantation of these meshes decreased the hernia recurrence rate. According to a randomized clinic study, the recurrence rate for inguinal hernia was 1% when surgical mesh was used to repair inguinal hernia and the recurrence rate for inguinal hernia was 7% when the inguinal hernia was repaired without the surgical mesh. (2)

Which Surgical Meshes Do We Have?

As Boz Medical, we offer 3 different surgical meshes under surgical mesh category to use the right product for the treatment of all types of hernia. All absorbable, non-absorbable and semi-absorbable synthetic surgical meshes have the ideal pore gap for tissue healing and accelerates the tissue healing with braided structure. Our meshes are flexible, strong and transparent without clustering and with long-term durability. (6)

Monoprolen Mesh

Monoprolen Mesh is a non-absorbable, dye-free and synthetic surgical mesh with polypropylene (PP) filaments. This surgical mesh with monofilament and non-absorbable structure is sterilized with ethylene oxide. The polypropylene polymer structure is the same as the Monoprolen Suture in our suture category. (4, 6)

Since Monoprolen Mesh is uncoated and has the ideal porosity, this mesh offers additional support to weak or damaged tissue. This mesh type that gives high force and durability as well as spatial stability for surgical operation region does not shrink due to thin mesh structure. (4, 6)

Caprolen Mesh

Caprolen Mesh is a two-component semi-absorbable surgical mesh with polypropylene and poly (glycolid-co-caprolacton) (PP and PGCL) segments. Caprolen mesh surgical mesh is used for repairing soft and sensitive tissues such as hernia. This surgical mesh is sterilized with ethylene oxide and it is a light mesh with perfect grip thanks to uncoated structure. This mesh offers high-level initial hardness like the heavy meshes as well as perfect flexibility after absorption (soft mesh). After the poly (glycolid-co-caprolacton, 75/25) components absorbed, a polypropylene mesh stays in the surgical operation region to support the tissue. Poly (glycolid-co-caprolacton, 75/25) structure is the same as the Monokaprol Suture in our suture category. (3, 6)

Bacteria colonization is prevented with monofilament structure and infection risk is minimized. Thus, pain and discomfort are minimized as well. This surgical mesh offers better tissue grip thanks to large pores and the purple strip on the mesh is created to facilitate placing the mesh to surgical operation region such as inguinal hernia repair. (3, 6)

Gliko Mesh

Gliko Mesh is a synthetic, absorbable and sterile copolymer with 90% glycolid and 10% L- lactide (gylocolic and lactic acid). The co-polymer structure is the same as Glikolak synthetic absorbable suture in our suture category. This surgical mesh is sterilized with ethylene oxide and it has colourless (natural) and purple coloured versions. (5, 6)

Gliko-Mesh is a surgical mesh designed to offer temporary support to healing tissues. The mesh can be cut in desired shape and size for surgical operations. This mesh is often used in hernia problems in children due to absorbable property. (5, 6)

BIBLIOGRAPHY

(1) Cerrahi Mesh – Yama (n.d.). Obtained from https://www.turkcerrahi.com/

(2) Metin Ertem, Emel Özveri, Hakan Gök, Acıbadem Kozyatağı Hastanesi, Genel Cerrahi, İstanbul, Türkiye (2011): Hiatal fıtıklarda yamalı onarım: Cerrahi teknik ve erken dönem sonuçlarımız.

(3) Caprolen Mesh – Polyproplene (PP) Sterile Synthetic Partially Absorbable Composite Mesh – Prospectus (n.d.). Boz Medical. Access address: https://www.boztibbi.com/wp-content/uploads/2021/11/Monoprolen-Mesh-Prospektus.pdf.

(4) Monoprolen Mesh – Polypropylene (PP) Sterile Synthetic Nonabsorbable Mesh – Use Instruction – Prospectus (n.d.). Boz Medical. Access address: https://www.boztibbi.com/wp-content/uploads/2021/11/Monoprolen-Mesh-Prospektus.pdf.

(5) Gliko Mesh – Poly[glycolide(90%)-co-lactide(10%)] Sterile Synthetic Absorbable Mesh – Use Instruction – Prospectus (n.d.). Boz Medical. Access address: https://www.boztibbi.com/wp-content/uploads/2021/11/Glikomesh-Prospektus.pdf.

(6) Surgical Mesh (2021). Boz Medical. Access address: https://www.boztibbi.com/en/products/surgical-mesh/

Our skin is the first defence line for our body against the external threats and it forms the 15% of body weight as the largest organ after the skeleton system. (5) Wound or wound damage is the damage to the anatomic and functional integrity of skin and subcutaneous tissues which are epidermis, dermis and panniculus due to any trauma. (1, 5) As a result of any deterioration on the skin, new tissue begins to form at the site of the damaged tissue as a result of cellular and biochemical events that start regularly and sequentially, and this is defined as wound healing. (2) Although this process looks simple, it is a series of complex events consisting of multiple stages and elements. In this article, we will look into wound types, wound shapes and reasons. (3,4)

What Are Wound Types?

Wound is any damage to tissue integrity and the physiologic recovery and repair with tissue changes in the healing process following the damage. Chronic wounds are wounds that don’t heal easy and leave marks on the body.

Wounds are divided into three. The first one is erosion wounds which are superficial wounds that don’t penetrate to dermis and leave a mark. The second one is vertical wounds called fissures. The third one is ulcer which is chronic and deeper than erosion wound. These wounds penetrate to dermis, leave a mark and the treatment is hard. (5) Also, the wounds can be divided into two groups as acute and chronic wounds.

What Are Acute Wounds?

Acute wounds are wounds that start and end and fade away fast. These have temporary impact, heal faster, the number of elements to prevent healing are low and the healing is continuous. Post-op wounds or operation wounds can be given as an example to acute wounds. (5,6)

What Are The Reasons for Acute Wounds?

The name acute wound means “instantly developing” wounds. Therefore, instant “acute” wounds occur on damaged tissue after trauma. The reasons for acute wounds can be listed as contusion due to crushing of the tissue, abrasion due to shearing, laceration due to tearing, chemical or physical burns, bites made by animals or humans or surgical incisions called incisions and penetrating due to conditions such as stinging, puncture, gun injury, insect bites.

Acute Wound Recovery Period

The acute wound recovery is fast and regular when the necessary treatment is applied. There are few reasons to prevent wound healing and scar tissue formation is regular. As a result, the healing is continuous and the tissue recovers in around 4-5 weeks and go back to its former state.

What Are Chronic Wounds?

Chronic wounds are formed systematically and the healing takes a lot of time. In some cases, these wounds might not heal. The impact is continuous which means there are numerous factors such as venous, nervous or cell-based that elongate or prevent healing. Feet wounds in diabetes and cancer-related ulcers can be given as chronic wound examples. (5,6)

What Are The Reasons for Chronic Wounds?

The general factors for chronic wounds are smoking, irregular and uncontrolled nutrition and as a result of obesity, problems seen in advanced age, vitamin deficiency or trace element deficiency, malignant tumours, chemotherapy or radiotherapy methods used in cancer treatment, drugs that weaken the immune system (Warfarin, Heparin etc.) and diabetes mellitus.

Chronic Wounds In Diabetes

The repetitive wounds that don’t heal over time are called chronic wounds and the general factors are given above. Diabetes must be highlighted and it is one of the main diseases that cause chronic wounds. Diabetes which is a chronic diseases damaged nerves and vein tissues over time, cause blood circulation problems and lead to wounds on various parts of the body and especially on feet. When the problem progresses, it can lead to vascular occlusion and even loss of feet or legs. (8)

Varicose Vein

These wounds are often see on ankles and front part of the leg and these are formed due to malfunction of venous valve problems. The blood leaks back and accumulates in vascular access. Therefore, the pressure increases and the veins swell. (7, 8)

Compression Ulcers / Decubitus

This wound is often seen on bedbound or wheelchair bound patients and it is due to pressure on the same part of the body. The shape, stage and depth of the chronic compression wounds can be different.

What Are The Differences Between Open and Close Wounds?

What Is An Open Wound?

We can divide open wounds into two sub-groups. These are: These are clean cuts by sharp objects such as knife, razor or glass which are called incisions. Another open wound type is the irregular, tear-like wounds caused by blunt trauma, also known as lacerations.

• The integrity of the skin or subcutaneous tissue is damaged due to trauma.
• These are due to contusion, penetrant, laceration or incision. (see also: paragraph 4)
• The wound is not bandaged and it continuously contacts with air.
• The wound might be infected with the necessary treatment and wound dressing aren’t applied. As a result, the recovery can take longer and the wound can become deeper. (1)

Close Wounds

These wounds are blood accumulation between the tissues and tissue gaps due to trauma.

• The tissue integrity is preserved.
• These wounds can have different forms such as crush, sprain, or joint or intramuscular hematoma. (1)

What Are Wound Types for Shape?

Contusion

These are wound due to crushing the tissue by a heavy load, stone, bar or an impact from a traffic accident. The bleeding risk is low but these wounds can be life threatening due to internal organ damage. (5,9)

Incision Wounds

These are simple wounds created by glass, knife or sharp objects. The wound can be superficial or deep depending on the depth of the incision and the depth of the wound can be seen easily. Depending on the depth, these wounds can be life threatening. (5,9)

Abrasion Wounds

These wounds are the damage on the epidermis and bleeding on capillary vessels due to abrasion. There might be pain since the nerve ends are damaged. (5,9)

Penetration Wounds

These are the wounds due to penetration by a bullet, needle, sharp object or wire. Since these wounds are deep, large vessels such as arteries and internal organs might be punctured. These wounds can be life threatening or cause tetanus risk depending on the depth of the wound and the sharp object. (5,9)

Fragmented Wound

These wounds are caused by partial or complete rupture of the skin or subcutaneous tissue. Since there will be extensive bleeding, the individual might die because of blood loss. (5,9)

Bibliography

(1) Prof. Dr. Varlı M. Yara iyileşme süreci ve etkileyen faktörler. Yaşlı Bakım ve Teknikerleri Yara Bakım Eğitimi. 2019

(2) Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiological reviews. 2003;83(3):835-70.

(3) Hormozi M, Assaei R, Boroujeni MB. The effect of aloe vera on the expression of wound healing factors (TGFβ1 and bFGF) in mouse embryonic fibroblast cell: In vitro study. Biomedicine & Pharmacotherapy. 2017;88:610-6.

(4) Fizyoaktif – Medical Trainer. “Yara İyileşme Fizyolojisi” Son güncelleme 26 Ağustos, 2021. http://fizyoaktif.com.tr/?p=965.

(5) Prof. Dr. ARAS, Sevgi “Yara Nedir? Tipleri, Evrelendirme” AÜTF – Geriatri Bilim Dalı (erişim 26.08.2021)

(6) Prof. Dr. KARGI, Eksal “Kronik Yara Nedir?” Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği (erişim 27.08.2021)

(7) Op. Dr. KARACA, Yaşar “Varis nedir? Belirti ve tedavi yöntemleri nelerdir?” Medical Park (erişim tarihi 27.08.2021)

(8) Kolan British Hospital “Kronik Yara Bakımı (Bası Yaraları, Venöz Ülserler, Diyabetik Ayak)” Son güncelleme 27 Ağustos, 2021. https://kolanbritish.com/tibbi-birimler/plastik-estetik-ve-rekonstruktif-cerrahi/kronik-yara-bakimi-basi-yaralari-venoz-ulserler-diyabetik-ayak/

(9) Sağlığım “Yara Nedir?” T.C. Sağlık Bakanlığı https://sagligim.gov.tr/yaralanmalarda-ilk-yardim/yara-nedir.html (erişim 27.08.2020)

Wound is the damaged anatomic integrity of a tissue due to any trauma. Applying the necessary treatment to stop the bleeding and to connect the damaged tissue date back to thousands of years ago. The development of surgical sutures in line with the developments of surgery in the history of medicine led the sutures to pass through different phases. In ancient ages, the deep wounds were sutured with plant materials such as linen, cotton, silk and animal tissues such as animal gut or skin, horse – pig hair, tendon and nerve to prevent bleeding and infection for wound healing. (2)

This surgical material called sutures in the modern medical literature has significantly developed from the old ages and still continues to develop with various research. The name suture for natural or synthetic materials comes from Latin and this term was first used by Hippocrates in 400 BC. (4) Today, synthetic materials are often preferred as a suture raw material. However, raw materials from organic polymers such as silk and catguts manufactured from animal mucosa are actively used for surgical suture manufactured for certain scenario.

First Period – The Oldest Surgical Document of The World: Edwin Smith Papyrus

Edwin Smith Surgical Papyrus which was discovered as a piece of a coursebook in ancient Egypt is recorded as the oldest surgical document. When this historical document in Egyptian hieroglyphs was investigated, it was found that the word structure dated to 1600 BC but the content dated to older times around 3000-2500 BC. This document mentioned methods to close the wounds with sutures and preventing the infection for the sutured wound. The cranial sutures (the fibrous tissue that connects the scalp bones) in this surgical document contain the first known explanations about the brain surface and cerebrospinal fluid. (9, 10)

The oldest and well-preserved sutures on the human body was found on a mummy of the 21st Egyptian Dynasty (around 1100 BC). The sutures were on the belly, knee and elbow of the mummy. (3) Societies from different cultures in the ancient period used such as horsehair, gut, dry tendon or hair, or gold and silver wires as suture material. (2,4,10)

Hippocrates who was one of the best surgeons of all times mentioned using sutures to close the veins and tissues. Roman Galen, one of the best physicians of the period after Hippocrates, mentioned flax, silk and catgut for suturing wounds in his book named ‘De Method Medendi’.

Second Period – Adolescence of Medicine

There were important developments in surgery which became an occupation in the 18th century. This period from 1860s to 1930-50 was marked as the adolescence of medicine. The surgical methods developed in this period but the pain and ache during and after the surgery halted this advancement in the surgical field. For this reason, the pain issue was solved with surgical anaesthesia in 1840 which was considered as one of the greatest inventions of human history. But the infection problem required a long time to solve which was the 19th century when the modern surgery was born. Due to post-op infections, the sutures didn’t last and the patients mostly died from sepsis. (4,7,8)

Third Period – Modern Surgery

Anti-sepsis and asepsis technique developed in the second half of the 19th century which shaped the modern surgical methods in current form were considered as an important stage to eliminate the postop infection problem. The term anti-sepsis first used in 1750 by John Pringle which is defined as removing the pathogen microorganisms from the surgical operation area and “antiseptic surgical” method developed by Joseph Lister for the surgery led to important developments in wound treatment and suture material. (3,4,9)

From the beginning of the modern surgery until today which is referred as the third period, surgical sutures significantly developed. Further, R&D studies to create the ideal suture materials are ongoing. Boz Medical that has an important role in medical textile manufacturing in Turkey has the success and right product to be the first medical textile manufacturing firm in 1960s. The same success is visible for surgical suture manufacturing.

Bibliography

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(2) Atıcı T., Atıcı E., Şahin N., “Geçmişten günümüze cerrahi dikiş ipliklerinin tarihsel gelişimi”. Ulusal Cerrahi Dergisi 2010; 26(4): 233-242

(3) Black JJ. A stitch in time-1. The history of sutures. Nurs Times 1982; 78: 619-623.

(4) Snyder CC. Sütürün tarihi üzerine. Plast Reconstruct Surg 1976; 58: 401- [DOI: 10.1097 / 00006534-197610000- 00001]

(5) Trier WC. Considerations in the choice of surgical needles. Surg Gynecol Obstet. 1979;149:84-94.

(6) Köhle Ü, Demir CY. Oftalmik Cerrahide Sütür Materyalleri. İnönü Üniversitesi Tıp Fakültesi Dergisi. 2003;10:217-21

(7) Dereli, T . “SÜTÜR MALZEMELERİ VE SÜTÜR TEKNİKLERİ”. Güncel Dermatoloji Dergisi 1 (2016 ): 24-33

(8) Edwin Smith Surgical Papyrus 1600 B.C. Page 38. The Medical Book: From Witch Doctors to Robot Surgeons, 250 Milestones in the History of Medicine. 2012

(9) Özdoğan, Mustafa. Edwin Smith Cerrahi Papirüs MÖ 1600 – En eski cerrahi belge “https://www.drozdogan.com/edwin-smith-cerrahi-papirus-mc-1600-en-eski-cerrahi-belge/ 15.02.2021”

(10) Feldmsn RP, Goodrich JT. The Edwin Smith sutgical papyrus. Child’s Nerv Syst 1999; 15: 281-284. [DOI:10.1007/s003810050395]

(11) Tarhan, Ömer Rıdvan. Cerrahinin Tarihçesi “https://www.drozdogan.com/edwin-smith-cerrahi-papirus-mc-1600-en-eski-cerrahi-belge/ 15.02.2021”