It’s hard to think of a surgical product in which the technique of use doesn’t have a bearing on the successful function outcome. Whether it’s a joint replacement, a heart valve, or even a suture, getting the best from the product demands a degree of learning in order to optimise performance. In all cases there are hints and tips, proudly presented as each individual practitioner’s “way I do it”.
TissuePatch is no different. Despite the fact that most people score it 4 or 5 out of 5 for both ease of use and effectiveness on even their first use, experience tells us that recognition of the variables and adapting of technique is all important.
So what are these variables and how can the surgeon adapt his technique to them to achieve the best outcome?
Handling: Keep the product dry and handle as little as possible before presenting it correct side down to the tissue surface…if you can read the logo it’s the right side down.
Wetness of tissue surface: Too wet is too bad…the product’s chemistry will activate onto the fluid and not the underlying tissue surface. Subsequent drying and reapplication of the same patch will not work. Too dry is less of a problem, despite the fact that some moisture is required to kick start the bonding process. So the guidance is to get a feel for what looks right.
Repositioning: If it’s on, it’s on. Limited repositioning is possible if only partial and short term contact has occurred, but if the patch is largely “on”, then repositioning will not get a good result. Remember the product works by the action of its chemical interaction with proteins on the tissue surface. Once the chemisty has been activated, it won’t be available for subsequent reactivation.
Holding time to tissue surface: This is likely to be a minimum of 30 seconds….some surgeons prefer a minute and indeed some more challenging tissue surfaces demand this. If in doubt, leave it a minute, but once it’s on the tissue don’t “test” it too rigorously or its bonding action could be disrupted. Get used to the idea of leaving it and trusting it.
Wet swab or dry swab to hold patch in place? Damp seems to encourage softening of patch more quickly with associated conformance to tissue surface.
What about VATS cases, where tissue is quite dry and swab cannot be applied? There is no doubt this is the toughest challenge for the patch…the tissue surface is usually very uneven, with a ridge of staples and the lung deflated (vs three quarter inflated for open cases). It’s very difficult to apply firm and stable pressure to the entire area, so surgeons naturally try to use point pressure using “peanuts”. This seems to be the only practical solution, but generates two potential problems. Firstly the patch is rarely held still across its contact area, which may compromise the formation of the microscopic bonds we know hold it to the proteins on the tissue surface. Secondly it’s tempting, especially when a quick fixation is not achieved, to keep trying. There is a point at which continued “fiddling” will not improve the result, so the advice is to learn when to stop.
Note, these are not official recommendations and don’t appear in Instructions for Use. They are a few thought provokers from our experience of observing surgeons at work.
