Detrol

Rao R. Ivatury, MD, FACS

• Professor of Surgery, Physiology, and Emergency
• Medicine
• Chief, Division of Trauma, Critical Care, and
• Emergency Surgery
• Medical College of Virginia
• Virginia Commonwealth University
• Richmond, Virginia

The moist symptoms gallbladder cheap 2 mg detrol free shipping, irritant nature of the purulent infuenzae medications 563 discount detrol 1mg with amex, Streptococcus pneumoniae symptoms ruptured spleen buy discount detrol line, and Moraxella catarrhalis symptoms after flu shot order 4mg detrol visa. Stigmata Clinical diagnosis of bacterial rhinosinusitis is made by 1 9 suggestive of genetic syndromes should be noted because fndings of prolonged symptoms of rhinorrhea without congenital nasal anomalies. A viral etiology is far by the most com Cocaine, marijuana, and inhaled solvents may result in mon; bacterial etiology is less common. Nonallergic infammatory rhinitis with suggestive of juvenile nasopharyngeal angiofbroma. Unilateral choanal atresia The vasomotor responses of increased secretion and mu presents later with chronic unilateral rhinorrhea that can be 4 cosal swelling are the normal responses of the nasal mu clear or purulent. The autonomic system response, hormones, Infants with congenital syphilis may present between the and stress are other triggers. Chronic mucopurulent rhinorrhea, septal perforation, and saddle nose deformity are late complications. Viral phar yngitis is usually gradual in onset with early signs of fever, malaise, and anorexia generally preceding the sore throat. The test is not 1 with a cold or documented group A streptococcal infec considered reliable in children younger than age 5 because of a tion is helpful. It is not Acute onset of illness with associated symptoms of stridor, 2 routinely sought in the evaluation of pharyngitis. The disease is suggested by a systemic illness with accompanying ulcerating vesicles throughout the orophar and grayish membrane over the tonsils and pharyngeal walls. Culture of the organism and enteroviruses cause herpangina, including enterovirus 71, al confrmation of its toxin are necessary to confrm the diagnosis. Tese are followed by development of a maculopapular is present, group A streptococcus should still be considered rash that begins on the forehead then spreads downward. The occurrence of conjunctivitis, rhinitis, cough, and urine, or respiratory secretions). Signifcant diarrhea also makes streptococcal disease Immunocompromised patients are at risk for fungal oro 14 unlikely. Viral pharyngitis is most commonly accompanied by Agranulocytosis may manifest as pharyngitis with a white 6 15 common cold symptoms such as rhinitis and cough. Congenital hyperthyroidism in infants born to mothers with Graves disease may cause a goiter that usually resolves in 6 to 12 weeks. Most neck masses are benign, but it is important not to miss rare malignant masses. They birth, or with chronic drainage or recurrent episodes of swell appear as sof, compressible masses just lateral to the midline. Branchial clef anomalies include cysts, sinuses, and fstu 8 Symptoms indicating compression of the trachea, esophagus, las. Tere is a frm, nontender, fbrous mass is bounded by the sternocleidomastoid, the distal two thirds of within the body of the sternocleidomastoid. It is believed to be caused by trauma or abnormal posi show fuctuance and transilluminate. Approximately one third are not diagnosed until afer the dibular or submental region. They may be difcult to distinguish 11 ofen enlarging in the frst year of life, followed by involution. Chapters 240, 308, 494, 497, 559, 560, 561, 562, 614, 640, 642, 672 Nelsons Essentials, 6e. Chapter 175 10 Part I u Head, Neck, and Eyes Salivary gland enlargement most commonly involves the a signifcant proportion of patients eventually become hypothy 12 parotid that obscures the angle of the mandible but may roid, an occasional patient has hyperthyroidism. Endemic goiter due to iodine de with tender, swollen parotid glands classically caused by mumps fciency is rare in the United States, with iodized salt availability. In suppurative Goitrogenic drugs include lithium, amiodarone, and iodides in parotitis caused by Staphylococcus aureus, pus can be expressed cough medicines. Bilateral enlargement of submaxillary glands may occur in Children with Pendred syndrome. Parotid enlarge genital deafness) are ofen euthyroid but may be hypothy ment occurs with chronic emesis as in bulimia. It is believed to be caused by a defect in hormone synthe formation may be associated with anticholinergic antihistamine sis. In addition to the thyroid, there is increase in size of are rare, and they are usually benign. Patients exhibit classic signs and symptoms of hyperthyroidism, A goiter is an enlargement of the thyroid. Hyperthyroidism may rarely be fne needle aspiration or open biopsy are diagnostic indicators seen with McCune-Albright syndrome and hyperfunctioning of carcinoma of the thyroid, including papillary, follicular, thyroid carcinoma. Benign adenomas may Rhabdomyosarcoma may occur with cervical node en also appear as solitary nodules. If it occurs before age 2, there may be strates hot or cold areas, which indicate increased or de hypopigmentation of the iris on the afected side. In hydranencephaly the cerebral hemispheres are absent 5 or represented by membranous sacs. A pediatric neurosurgeon should be consulted for of percentiles is of more concern than the case of a child with a recommendations. Tese include lysosomal diseases A birth history, developmental history and history of irri 1 (Tay-Sachs disease, gangliosidosis, mucopolysaccharidoses), tability, headaches, and visual problems are important maple syrup urine disease, and leukodystrophies. Tese children may have mild neu Familial microcephaly is ofen associated with some 10 rodevelopmental dysfunction. Chapter 187 14 Part I u Head, Neck, and Eyes Skull deformational malformations occur as the result of because of compensatory growth. Symmetric occipital fatten 12 an alteration of the normal forces (in utero, perinatal, or ing that is believed to be positional does not require imaging. Plagiocephaly is a benign condition Pfeifer syndromes, congenital hyperthyroidism, and adrenal that must be distinguished from true cranial suture synostosis. In plagiocephaly, sutures are open, and a frontal and temporal Imaging is recommended except in the case of a crying prominence occurs on the same side as the fat occiput. It can occur second ical conjunctivitis unless membranes were ruptured prema ary to a wide range of etiologies. Silver nitrate is more likely to produce this condition than The age of onset of the red eye, the nature of any discharge, other agents used for prophylaxis. In older children, and the associated signs and symptoms are the most important components of the history. History of exposure to chemical irritants may include cosmetics or eye medications. Conjunctivitis within the neonatal period (4 weeks of Subconjunctival hemorrhage may occur with vomiting, 2 9 birth) is also known as ophthalmia neonatorum. It may also occur in newborns common causes in the United States are Staphylococcus aureus, afer vaginal delivery. Allergic conjunctivitis is characterized by itching, chemo 10 sis, papillae of the tarsal conjunctivae, and white stringy Ophthalmia neonatorum also can be caused by Chlamydia discharge. In limbal vernal conjunctivitis, a ring of swollen con 3 trachomatis, Neisseria gonorrhoeae, and herpes simplex virus junctiva surrounds the limbus of the cornea. Vesicles or erosions are present on mophilus infuenzae, pneumococci, staphylococci, and strepto the lid or surrounding skin. Ophthalmologic consultation is indicated when herpes Iritis and iridocyclitis may occur secondary to localized 13 is suspected. Chapter 119 18 Part I u Head, Neck, and Eyes Pain with extraocular eye movements may accompany The lacrimal gland.

Syndromes

• Has a seizure
• Muscle biopsy  
• Your symptoms get worse or do not improve with treatment
• Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds.
• Prepare your home for your return from the hospital.
• MRI of the abdomen
• Brainstem auditory evoked response (BAER)
• Irritability

Of note medications on airplanes buy discount detrol 1 mg on line, only 35% of women in the analysis were age 21 or older at the time of explosion medicine hat lodge buy detrol 1mg mastercard, thereby limiting the inference of this work to female veterans who served in Vietnam symptoms vs signs safe detrol 2mg. These have included risk for the development of diabetes and metabolic syndrome 30 years after the accident (W arner et al treatment 1st degree heart block purchase detrol 2 mg without prescription. The as sociations of adverse pregnancy outcomes and proximity of maternal residence (10 kilometers or fewer) with municipal solid waste incinerators with high dioxin emission levels at the time of birth have also been examined (Tango et al. The emphasis of environmental studies in Japan has been on the long-term follow-up of the 1968 Yusho rice oil poisoning accident. Because of changes in the symptoms and advances in analytic techniques, the diagnostic criteria have changed several times since they were frst published in 1968 (Akahane et al. The frst is the Sapporo (Toho Hospital) cohort with one obstetric hospital, and the second cohort is the much larger Hokkaido cohort, which has 37 hospi tals and clinics. The primary study goals are to examine the effects of low-level environmental chemical exposures on birth outcomes; to follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders and perform a longitudinal observation of child development; to identify high risk groups based on genetic susceptibility to environmental chemicals; and to identify the additive effects of various chemicals, including tobacco smoking (Kishi et al. A self administered questionnaire was completed at the time of enrollment to obtain parental baseline information. Follow-ups and the administration of neurobehavioral developmental tests were conducted at ages 6 and 18 months and 3. The focus of investigations using the Sapporo cohort are on child neurobehavioral development, but the development of asthma, allergies, and infectious diseases is also examined. The Hokkaido cohort enrolled 20,926 pregnant women before 13 weeks of gestational age who visited one of the associated hospitals or clinics in the Hok kaido prefecture between February 2003 and M arch 2012 (participation rate of 55%). A simultaneous analysis of 11 perfuorinated alkyl substances in maternal plasma collected during the third trimester of pregnancy was conducted. Follow-ups of the children were conducted at 18 months and 3 years of age and began in October 2013 and January 2015, respec tively. The follow-ups of 5 and 6-year-old participants started in October 2014 (Kishi et al. Four publications using subsets of the cohort data were iden tifed and reviewed in this volume. The samples were tested for total dioxin levels (as the sum of 29 congeners) and genotyping for genes coding three enzymes involved in dioxin metabolism. The genotype status was previously shown to be related to birth weight in 484 children in the Hokkaido cohort. From 1967 to 1987 the plant pro duced hexachlorocyclohexane (lindane) and its derivatives, and many of the workers experienced chloracne. Although 516 peripubertal boys (identifed through health insurance and clinic records) were enrolled, the fnal cohort consisted of 499 boys and 449 mothers. Annual follow-up examinations were also conducted (9-year retention rate of 73%), blood is collected biennially, urine is collected annually, and semen collection began in 2012. The published fnd ings have detailed the characterizations of serum concentrations in the boys (J. Russ Hauser, and is able to offer a bit more detail regarding initial fndings based on his presentation. Participants were recruited within 2 months after their 70th birthdays randomly from the registry of residents of the community of Uppsala, Sweden, between April 2001 and June 2004. Of the 2,025 subjects who were invited to participate, 1,016 were included, for a participation rate of about 50%; half 2Dr. All participants answered a questionnaire about their medical history, medications, diet, and smoking habits. However, the results are limited by the fact that participants were recruited in the 2-month period after their 70th birthday. In addition, an analysis of the association between each congener and the prevalence of metabolic syndrome was conducted. Using the same cross-sectional study with enrollment extended to December 2009, J. One limitation is the use of the Framingham score; other factors are associated with risk but were not included in the score, such as socio economic position, genetics, and imaging biomarkers. There may also be important unmeasured confounders related to which workers moved away and which ones did not. Three new studies among the residential population near this factory were identifed and reviewed in the current volume. The placenta was collected from and the questionnaire completed by 430 participants. In addition to anthropomorphic measures used in previous waves, reproductive development (breast, genital, and armpit stages) was assessed. In a review paper, Constable and Hatch (1985) summarized the unpublished results of studies conducted by researchers in Vietnam. They also examined nine reports that focused primarily on reproductive outcomes (Can et al. Vietnamese researchers later published the results of four additional studies: two on reproductive abnor malities (Phuong et al. In total, 10 new studies of outcomes in the Vietnamese population were identifed and reviewed for the current volume. However, no results were reported on associations between the concentrations of these chemicals in mothers and health status in mothers or infants. Two new studies of mothers and their children in different herbicide-contaminated and non-contaminated areas in Vietnam were reviewed in the current volume (Anh et al. The recruitment and residence area includes two districts in a surrounding area of 10 kilometers from the former air base. This is because the residents outside the immediate area of the airbase have also been shown to have high dioxin levels suspected to have been caused by the ingestion of contaminated food and water originating from the air base. Dioxins were measured at birth and 5 years of age and compared with outcomes of the M ovement Assessment Battery for Children-2 test and other tests of pattern reasoning, planning ability, and neurodevelopmental skills. Analyses were adjusted for age and included stratifcation by occupation, including farmers and other non-farm occupations. Results of this study are limited by its cross-sectional design and, in particular, the relatively crude measurement of exposure assessment many years after the time when herbicide spraying would have occurred. However, these studies are somewhat limited in that these measures do not serve as indicators or even sur rogates of health conditions or diseases of primary concern to Vietnam veterans. Similarly, overlapping case-control studies have been conducted among New Zealanders exposed to phenoxy herbicide and chlorophenols examining incidence and mor tality from specifc cancers (Pearce et al. Studies have included leukemia mortality among white farmers in Nebraska (Blair and Thomas, 1979; Blair and W hite, 1985), Iowa (Burmeister, 1981; Burmeister et al. Other lymphohematopoietic cancer outcomes investigated as case-control studies in U. Non-cancer health outcomes have also been investigated in case-control studies: birth defects and congenital anomalies (Blatter et al. Starting in October 1, 1997, the individual centers began monitoring births in their respective areas for the occurrence of more than 30 types of birth defects (excluding cases attributable to single-gene conditions or chromosomal abnormalities) for comparison with randomly selected sets of live-born babies without malformations. Information about demographics and possible exposures is abstracted from an extensive telephone interview that the mothers complete within 24 months of delivery. On the basis of the work his tories, job classifcations are assigned by an industrial hygienist and processed using a job-exposure matrix and expert opinion used to derive occupational ex posures.

If recording the full nine-digit zip code medicine 7 generic detrol 4mg visa, no dash should be placed between the first five and the last four digits keratin intensive treatment buy 1mg detrol. This website is useful in obtaining missing address information in order to record a complete address symptoms non hodgkins lymphoma proven 2mg detrol. If the patient is a resident of a foreign country at the time of diagnosis treatment 1st degree heart block buy 4 mg detrol visa, record 88888 for the zip code. If the patient has multiple tumors, the county codes may be different for each tumor. Explanation this data item may be used for epidemiological purposes (for example: to measure the cancer burden in a particular geographical area). If the patient has multiple tumors, the country codes may be different for each tumor. Coding Instructions Enter the appropriate alpha-3-digit code for the country of residence. Document in Text Remarks-Other Pertinent Information that the social security information is unavailable. Example: 777771234 Note: All efforts must be made to obtain the complete social, but if only the last four digits are provided they now can be used in the social security number field and not just documented in the pertinent information text box. Example: the record indicates the patient was born in 1978 but no month or day is given. Note: If the complete date of birth is not available, documentation must be provided in Other Pertinent Information. If only the age of the patient is known, calculate the year of birth from age and year of diagnosis and leave the day and month of birth unknown. Example: A 50 year old patient diagnosed in 2010 is calculated to have been born in 1960. Every effort must be made to obtain this information as it is critical for analysis. The first four digits are the year, the fifth and sixth digits are the month, and the seventh and eighth digits are the day. If the patient has multiple primaries, the state of birth is the same for each tumor. Explanation Birthplace is used to ascertain ethnicity, identify special populations at risk for certain types of cancers, and for epidemiological analyses. Explanation Racial origin captures information used in research and cancer control activities comparing stage at diagnosis and/or treatment by race. Race is defined by specific physical, hereditary and cultural traditions or origins, not necessarily by birthplace, place of residence, or citizenship. Record the two-digit code to identify the primary race(s) of the patient in fields race 1, race 2, race 3, race 4, and race 5. The five race fields allow for coding of multiple races consistent with the Census 2000. Code race using the highest priority source available according to the list below (a is the highest and c is the lowest) when race is reported differently by two or more sources. Race 1 is the field used to compare with race data on cases diagnosed prior to January 1, 2000. There is a statement that the patient is Hispanic or Latino(a) and no further information is available. Example: There is a statement that Sabrina Fitzsimmons is a Latina but no further information is available. Note: Persons of Spanish or Hispanic origin may be of any race, although persons of Mexican, Central American, South American, Puerto Rican, or Cuban origin are usually White. Code race as 02 (Black) when the stated race is African-American, Black, or Negro. Code the race based on birthplace information when the race is recorded as Oriental, Mongolian, or Asian and the place of birth is recorded as China, Japan, the Philippines, or another Asian nation. If no race is stated in the medical record or available from other sources in your facility, review the documentation for a statement of a race category such as a patient described as a Japanese female. Persons of Spanish or Hispanic origin may be of any race, although persons of Mexican, Central American, South American, Puerto Rican, or Cuban origin are usually white. Do not code race from name alone, especially for females with no maiden name given. Example: Record states: the patient was Nigerian Code race as 02 (Black) per the Appendix. Death certificate information may be used to supplement ante mortem race information only when race is unknown in the patient record or when the death certificate information is more specific. A unique race code (other than 88 or 99) can be coded only once in race 1 through race 5. Patient photographs may be used with caution to determine race in the absence of any other information. The use of photographs alone to determine race may lead to a misclassification of race. If the face sheet states Other race and there is not more information about race in the medical record, if no further information is found, code Race 1 as 99, and code Race 2-5 as 99. A more specific race that is not included in the list of race codes such as 96 Other Asian, 97 Pacific Islander, or 98 Other Race should be documented as well. Note: A specific race code (other than blank or 99) must not occur more than once. For example, do not code Black in race 1 for one parent and Black in race 2 for the other parent. If a patient has a Spanish last name and she is stated to be a native of Indiana, code to 99, Unknown, because nothing is known about her race. Exception is done when Race is noted as other in face sheet; use code 99 for Race 1 and code 88 for Race 2-5. Race is defined by specific physical, heredity, and cultural traditions or origins, not necessarily by birthplace, place of residence, or citizenship. If more than the Race 1 code is entered, and if any race is 99, then all race codes (Race 1, 2, 3, 4 and 5) must be 99. If more than the Race 1 code is entered, and if any race codes (for Race 2, 3, 4 and 5) are 88 (no further race documented), then all subsequent race codes must also be 88. Code only the specific race when both a specific race code and a non-specific race code apply.

A high-quality study comparing tap water to sterile saline in a pediatric population showed no difference in infection rates at 48 hours medicine nausea purchase detrol with visa. However medicine advertisements order detrol with american express, the power of these studies to detect differences in infection rates may be too low to conclude inferiority medications names and uses discount 1 mg detrol. On balance medicine in french cheap detrol online visa, there appears to be no difference in infection rates between the common practice of using sterile saline for routine laceration repair or using regular tap water for uncomplicated extremity lacerations and either wound irrigation with sterile saline or tap water is recommended. There is no quality evidence supporting the use of concentrated povidine-iodine solution instillation into the wound, although a low-quality study suggests some benefit in reduced infection rates,(1378) another low-quality study found no difference in infection rates between normal saline, povidine, and Shur Clens. For lacerations that involve skin areas where significant hair may hamper closure efforts, removal by clipping rather than shaving is commonly suggested to reduce potential sources of contamination resultant from disturbing bacteria on hair shafts, although there is no evidence to support this method in routine laceration repair. Debridement of devitalized tissue through surgical excision and scrubbing may also reduce the risk of infection. However, there is one large moderate-quality study of 816 lacerations that showed no difference in infection rates in repair using sterile gloves versus non-sterile clean gloves,(1381) thus either is recommended. Author/Year Score Sample Comparison Results Conclusion Comments Study Type (0-11) Size Group Wound Irrigation Tap Water vs Normal/Sterile Saline Bansal 9. No saline for irrigating Sponsored by Age range (N = 21) difference in infection simple lacerations funds from 2-15. No difference in uncomplicated proportion of grants from ed soft gloves for infection rates traumatic lacerations follow-ups Canadian tissue uncomplicated (relative risk 1. Laceration sites: Research nonsterile extremities in Foundation of groups: Follow-up for 1 61. Anesthetic technique is most commonly performed based on wound location and the preference of the treating health care professional. Recommendation: Local Infiltration plus Topical Anesthetic or Digital Block for Finger Laceration Repair Adequate anesthesia by either topical anesthetic plus local infiltration or digital block is moderately recommended for finger laceration repair. For distal finger lacerations, digital block may be substantially less painful than local infiltration performed without topical anesthetic. If the operator and patient preference is digital block, the various techniques are described and evaluated in the management of phalangeal fracture section in this guideline. Recommendation: Local Infiltration for Extremity Wound Repair Instillation of local anesthetic for extremity wounds after sensory testing is recommended as the first-line technique for most laceration repairs unless the size or complexity would require potentially toxic doses of local anesthetic. There is one high-quality and one moderate-quality study comparing local infiltration to digital block for finger lacerations. However, in the high-quality study, both received topical anesthesia which may have otherwise confounded the results. Although there may be a modest advantage to digital anesthesia, there is not enough evidence to support one technique over the other, and both are recommended based on operator and patient preference. Topical anesthetics are applied to provide analgesia for subsequent local infiltration, or to provide anesthesia for wound repair. Topical anesthetics used for laceration repair without local infiltration are best used in highly vascularized regions, although they have also been used successfully in the extremity. Although local infiltration is the most common technique, there are no quality studies of local anesthetic infiltration versus placebo. Nor are there any quality studies comparing topical anesthetics to local infiltration or nerve blocks. As local infiltration is the gold standard for most wound repair, and the failure of topical anesthetics is treated by local infiltration or nerve block in complicated wounds, there is no recommendation for the use of topical anesthetics over local infiltration. There is one high-quality study comparing lidocaine solutions with buffering, the addition of epinephrine, and the use of diphenhydramine as an alternative(1391) for upper extremity wounds. Lidocaine with epinephrine with or without buffering was preferred by patients over diphenhydramine or buffered solutions without epinephrine. This result contradicts with common anecdote of using buffered solutions to reduce injection pain. Of the 10 articles considered for inclusion, 10 randomized trials and 0 systematic studies met the inclusion criteria. Study limited to 76 male) with tetracaine For physician ratings, difference sutures causing pain in the small lacerations (< 5 cm). No mention Age range 1 vs initial anesthetic application of to >17, mean placebo for and/or during wound repair; 83% sponsorship age 9 years. Successful initial Wound anesthesia did not differ complications significantlyin any of the assessed at 48 to anesthetic groups. May not be applicable to specified) anesthesia supplemental anesthesia, for 60 minutes require adults. Contaminated wounds or those at high risk of infection should be closed within 6 hours. Recommendation: Non-surgical Management of Non-complicated Hand Lacerations Less than 2cm in Linear Length It is recommended that non-complicated linear lacerations of the hand less than 2cm be managed without suturing by healing via secondary intention for some workers. Wounds should be carefully selected, not have tension, including not overlying or near joints and not have tension applied due to manual labor. Recommendation: Surgical Referral for Hand Lacerations with Evidence of Nerve Injury Immediate referral to a surgeon is recommended if the laceration shows evidence of a nerve injury. Recommendation: Suture Repair for Hand or Forearm Lacerations Suture repair is moderately recommended for lacerations of the hand or forearm as these lacerations respond well to common suture techniques and suture materials. There are no recommendations for one technique over another or for one suture material type over another. Recommendation: Use of Tissue Adhesive, Staples, and Surgical Tape (Steri-Strips) for Uncomplicated Laceration Repair Tissue adhesives, staples and surgical tape are moderately recommended for routine skin repair of non-complicated extremity lacerations within the limitations of repair strength equivalent to 5-0 suture material or higher. As many hand lacerations are small and uncomplicated, this study suggests non-surgical management for non-gaping uncomplicated lacerations of the hand may be appropriate. Although, a comprehensive recommendation for working populations is not made as the provider should consider tensile forces on the wound and other environmental exposures resultant from occupational duties that likely reduce the ability to use non surgical management for some patients in making a treatment decision. However, wound closure most commonly by suture techniques has been long performed making suture repair the basis for other comparison studies. Therefore, although there is a lack of supporting studies, suturing is considered first line for laceration repair, with the strength of other repair recommendations made against using secondary intent in non-infected wounds. Various suture techniques have been described to provide the approximation of skin margins. However, there is a relative lack of quality studies that are methodologically sound while also having sufficient follow-up time of greater than one year to derive robust conclusions regarding the relative merit of different suturing techniques. Optimal results are thought to be dependent on skin edge eversion to eliminate depressed scarring, elimination of dead space and minimization of tension of individual sutures to avoid tissue necrosis. Common techniques include simple interrupted, vertical mattress, and running sutures. There are two moderate-quality studies of suture techniques, although there were no direct comparisons between the common techniques. Two versions of vertical mattress were compared with no difference in outcomes in a low quality study. There is also a lack of quality data comparing suture types for extremity laceration repair. The available cosmetic studies are both methodologically weak and have inadequate follow-up times to derive clinically meaningful differences on cosmesis. In addition to evaluating different types of sutures, one moderate-quality study compared suturing to stapling and concluded that stapling is more cost-effective than sutures. However, no outcomes measures for cosmetic results or complications were presented. Disadvantages of wound characteristics (especially depth and length) and occupational tasks requiring considerable tension are considerable in working populations and are discussed below. The most commonly used tissue adhesive is octylcyanoacrylate also known as Dermabond.

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