Overused device - Hemigard

[CutsWithFury]

HEMIGARD® | Basal Cell Carcinoma | SUTUREGARD Medical | United States

suturegard.com

Why are only podiatrists using this? I have never seen an orthopedist brag about using this device.

How is this device different than using a large bite vertical mattress suture technique with 2-0/3-0 Nylon to reapproximate skin edges? I've never had issues closing a wound where I used large bite vertical mattress technique with heavier suture.

The marketing behind this company rivals lapiplasty. Throughout 2022 I have seen constant marketing behind lapiplasty and this device.

Again I've never seen the need for this device.

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[Pronation]

Wow, thanks for the heads up on this. I had never heard of it but will start booking all of my cases with this now.

 

[AttackNME]

Yea, I’ve seen people use it for mass excisions on healthy patients too which is ridiculous.

 

[Shiyuan]

I've never and will never use. Such a joke. Just suture appropriately and steri-strip if needed. This is one of many reasons why medicine can be pointlessly expensive.

 

[wakaflocka88]

They do it and post about it to brag on IG. And then their national sales rep - Alex - will repost on his IG 😂 this is again why poor training - low volume - lack of experience leads to new grads and pods using overly expensive stuff when not necessary majority of the time.

 

[shadesofgrey]

I’ve used it, mainly on TMAs/other amps or to close incisions that have dehisced. Personally I felt it worked better on closing higher risk incision sites than vertical mattress sutures alone. It is not cheap though. I started using it on some diabetic dehisced wounds after I received a free box at ACFAS. Liked it enough to ask my office to order a box to have on hand in the office. For a box of 12 it was over $500, which was surprising. Won’t use it frequently because of the cost, but feel there can be a role for it. My 2 cents.

 

[Redsting]

I've used it a couple times on TMAs and once on a revision that the vertical surprisingly enough was tearing through/the skin was crap. But I have seen people on various social media post about it every other case regardless of the surgery.

 

[CutsWithFury]

I've used it a couple times on TMAs and once on a revision that the vertical surprisingly enough was tearing through/the skin was crap. But I have seen people on various social media post about it every other case regardless of the surgery.

If you are tearing through with the vertical than your bites are too small. I’m talking generous bites with 2-0/3-0 Nylon. I’ve never had an issue getting the skin edges approximated

 

[MalleableMan]

If an incision has tension across it I’d consider an incisional wound vac.

Maybe Hemiguard is supposed to substitute in cases you’d use an incisional vac?
I don’t really believe that Hemiguard has significant value outside of what a vertical mattress would accomplish though. Especially in areas that aren’t high risk. Maybe there’s a CPT code they suggest using with it….

HEMIGARD® Device Reimbursement | Retention Suture | SUTUREGARD

suturegard.com

 

[DYK343]

If an incision has tension across it I’d consider an incisional wound vac.

Maybe Hemiguard is supposed to substitute in cases you’d use an incisional vac?
I don’t really believe that Hemiguard has significant value outside of what a vertical mattress would accomplish though. Especially in areas that aren’t high risk. Maybe there’s a CPT code they suggest using with it….

HEMIGARD® Device Reimbursement | Retention Suture | SUTUREGARD

suturegard.com

I have no idea but im going to assume this is much cheaper than an incisional wound vac?

I can think of a few times where closure was tight after a long tourniquet time. Usually when I do triples or something similarly invasive.

I could see it being useful in that situation. This idea is not revolutionary. There are similar things on the market.

They are painful to remove for the patient. Ive only used something similar once but the patient was not happy at 2 week stitch removal.

 

[PODIATRYCRAZE]

Did I possibly run into some of you at the Desert Foot Conference?

 

[air bud]

Anyone want to comment on experience with incisionql wound vacs? Have used PICO a few times but would like to incorporate more into bigger recon. Have used for ankle fusion and Achilles before.

 

[Feli]

Edges are close but not quite = retention sutures with wide azz simples or verts = $5

Edges are not close = should have amped more = review surgery training...
...or, if you're a wound wizard, use Vac and grafts and more debride and more graft and more goops until they get their prox amp anyways

 

[DYK343]

Anyone want to comment on experience with incisionql wound vacs? Have used PICO a few times but would like to incorporate more into bigger recon. Have used for ankle fusion and Achilles before.

Ive never really had good experience with PICOs. Typically lose seal and overly macerated tissue. Maybe im just terrible at putting them on. But I cant think of a single time i've used one that I was happy I put it on.

In the rare situation I need one, for me, its traditional wound vac or bust - even though much more expensive good results is what im after.

 

[Pronation]

Anyone want to comment on experience with incisionql wound vacs? Have used PICO a few times but would like to incorporate more into bigger recon. Have used for ankle fusion and Achilles before.

Pico has been junk in my experience. Too weak, doesn’t keep good seal, and tiny canister fills up. I do like the prevena plus (with the larger canister). I usually try to have the patients admitted overnight and hookup the prevena foam to the big hospital vac overnight and discharge in the morning on prevena vac, this has cut down on the calls for full canisters and seal issues. Followup in 4-5 days.

 

[PatchAdamsFan]

Pico has been junk in my experience. Too weak, doesn’t keep good seal, and tiny canister fills up. I do like the prevena plus (with the larger canister). I usually try to have the patients admitted overnight and hookup the prevena foam to the big hospital vac overnight and discharge in the morning on prevena vac, this has cut down on the calls for full canisters and seal issues. Followup in 4-5 days.

Exactly my experience. Found it to work better than drains, which are tiny and get clogged as well.