Surgery in the 1990s

Depends, I think. If they could do it mostly by stent and scoping, then they could suture it closed because the surgery site would be very small. If they had to do fairly invasive surgery, staples could be used. They definitely had staples (a quick search brought a number of medical articles written in the 1990's discussing using staples and sutures in the same surgery procedures).

I think you would always be safe with sutures, as they still use sutures today for surgery.

Staples were used to close my C-section incision in 1996, if that helps you any. However, in a later natural (i.e. vaginal) childbirth, sutures were used to repair small tears.

Probably the size of the incision would determine sutures or staples.

In the early to mid 90's laparoscopy would not have been the norm. That would have been experimental which would be unheard of in a trauma patient. They might do a diagnostic laparoscopy if say the CT scanner was down and then converted to open as soon as they saw the blood. A long midline incision would have been typical. Closure with sutures or staples would depend upon who was the surgeon and whether they were in a training center with residents (generally but not always the first to have newer items) or if they were in East Bodunk where the supply room is 10 years behind the times. The older the surgeon and the more rural, the more likely it would be sutures. Staples are a lot more expensive than sutures. Also sometimes in training centers it might be sutures to give the interns some practice. So realistically you could do either and it would be ok. There also might be bolsters or retaining sutures (2 to 4 big honking things about 3-6 inches apart to lessen the lateral strain on the incision especially in chronically ill patients or with multiple traumas) in addition to the skin closure. In the early 90's they used staples as a time saver. You could close the skin in about 5 minutes with staples whereas sutures might be 30-45 minutes. Today there is a growing consensus that there are fewer wound infections with staples, but in the early days they left the staples in too long and there was more scarring. In an abdominal trauma patient it would also be standard to manually look at all the other abdominal organs, and back then depending upon the surgeon maybe do a prophylactic appendectomy so that should there be post op problems appendicitis can be ruled out.

Post op course would be 5-10 days in the hospital if it was a healthy patient, and 6 weeks until they are driving and back to work, but they really feel winded, easily tired and all manner of mild to moderate aches and pains for up to a year afterwards. What Lance Armstrong did was by far the exception.

WriterInChains said:

A friend of my MC gets in a freak accident & needs surgery to repair his ruptured spleen (at least I think that's what got smushed, it's not written in stone) -- would they have closed with staples or sutures?

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If it's a ruptured spleen ... they usually just remove it. But it's definitely got to get taken care of or he'll bleed to death.

Choice of exterior staples or sutures depends on physician preference and the patient's skin and underlying fat layer. Inner layers usually get dissolvable sutures, timed to degrade slightly after the tissues have healed.

hehe, I'm no doctor/nurse/etc so take the others' words for it. I typed in 1990's Staples Sutures Incision into google and yahoo and then just sifted through a lot of plastic surgery. PubMed might be a good resource for you too

WriterInChains said:

George, Thanks a million! You even answered the questions I didn't think to ask. Are you a doctor, nurse, EMT . . . ? Just curious.

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retired MD surgeon

Tsu Dho Nimh said:

If it's a ruptured spleen ... they usually just remove it. But it's definitely got to get taken care of or he'll bleed to death.

Choice of exterior staples or sutures depends on physician preference and the patient's skin and underlying fat layer. Inner layers usually get dissolvable sutures, timed to degrade slightly after the tissues have healed.

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No, usually the inner layers are permanent sutures because you don't want the patient to dehiss (have their guts spill out through the incision) and those are deep enough that the average American will never feel them. Mild splenic injuries were and are still often treated with observed bedrest. Hemodynamic instabilaty is somewhat up for interpretation and would be an indication for splenectomy.

Permanent isn't really "permanent" eventually even silk is degraded by most people's immune system.

Also in the early 90's it would be normal to give the patient a vaccine about 2-8 weeks post op (a prescription at the post op visit to go back to the family doctor for the vaccine) for pneumovax and sometimes meningococcus, (the bugs that the spleen fights that we have vaccines for)