Dr. Bill Lear illustrates how to use HEMIGARD on a lower leg wound while integrating the use of GluSeal.
It is important to clean the skin and dry it so the HEMIGARD device can be applied onto the patient’s skin. Once you have clean, dry skin, you can adhere a HEMIGARD strip on either side of the wound.
To maintain a clean and dry field throughout, it will require intermittent blotting of the wound as you can see his assistant is doing in the video below. The HEMIGARD strips should be placed no more than approximately 10 millimeters or more from the wound edge and the HEMIGARD strips will distribute the pressure of the high tension retention suture further away from the wound edge than using an unprotected suture.
Following the placement of the strips, you can take a 2-0 Nylon suture down through a hole on the HEMIGARD on one side and up through the hole on the other side. When you bring the wound edges together, you don't want to completely approximate or even worse over approximate to avoid the patient pulling the wound edges away with movement.
If a 2 - 3 millimeter gap is considered, it will make the next step much easier, which is placement of the dermal sutures. If you were to over approximate, it's more difficult at least to get that first dermal suture in place.
“So after I cut this, you'll notice that with that gap, it lets me go deep to superficial and superficial to deep with my dermal sutures. So I'll put one on one side of the retention suture, as you will see here and then I'll put another on the other side of the retention suture, and then go up and down each side of the wound with my deep sutures.”
The application is done under minimal tension using a 4-0 Polysorb, but could easily use a 5-0 Polysorb because that HEMIGARD and retention sutures are bearing the vast majority of any wound tension.
After you have done the layered closure, you can use sutures or staples. In Dr. Lear’s case because HEMIGARD is bearing the vast majority of the wound tension, he suggests that GluSeal is used -- especially if the patient doesn't have an acrylate allergy.
“It has multiple purposes. It's antimicrobial. It has a multi-use vial and you can use these individual pipettes to use only as much as you need per case.”
Following the application of GluSeal, the patient needs to apply a clean, non-adherent gauze like Telfa and wrap the wound until HEMIGARD removal.