Chapter 22: Surgical Equipment

INTRODUCTION

In austere situations, surgical instruments may need to be manufactured. Physician prisoners of war (POW) in World War II camps made surgical appliances from scrap materials using common items, including forks and spoons. With these rudimentary instruments, they performed thousands of successful operations.^1,2

A relatively simple method for obtaining basic surgical equipment is to recycle instruments that are labeled as “single-use” or “disposable.” The most common of these are disposable suture and suture-removal kits. Made completely of metal, they can be easily sterilized and safely reused.

WOUND GLUES

While cyanoacrylate (e.g., “Superglue”), either the medical or the household variety, is the most commonly available glue to use for closing wounds, others can also be used. The problems with nonmedical cyanoacrylates are that they may not hold the tissue well, may irritate the tissues, and may even have some toxic properties. Among those that have been used are wood glue, panel adhesive, hobby cement, and various native substances. One caution: When using glue to close a wound, tell the patient that he or she should avoid putting an antibiotic ointment on the wound. Most have a petroleum base that will dissolve the glue.

Cyanoacrylate

Availability

Cyanoacrylate, which comes in a wide variety of commercial brands for medical and nonmedical use, is a methacrylate resin that bonds surfaces almost instantly. Nonmedical cyanoacrylate is not approved for medical use, although the medical literature shows that it has been used without difficulty in multiple situations. (Remember, the techniques in this book are primarily for austere medical circumstances; if approved compounds are available, use them.)

Uses

Cyanoacrylates have been used successfully as a wound adhesive, for emergency dental repairs, and to treat corneal ulcerations and perforations, urinary and esophagobronchial fistulas, variceal bleeding, and esophagogastric varices (obliteration). They have also been used to repair peripheral nerves and for therapeutic embolism of vascular abnormalities.^3,4 During the Vietnam War, both liquid and spray forms of n-butyl cyanoacrylate were successfully used to control bleeding from penetrating wounds of the liver, retroperitoneum, kidney, pancreas, and vascular anastomoses after standard surgical treatment failed.^5,6 Simple lacerations that are closed with tissue adhesive not only show no difference in cosmesis compared to those that are closed with sutures, but also have reduced pain scores and shorter procedure times.⁷

Nonmedical superglues effectively close wounds in a similar manner to medical tissue adhesives. However, they are not sterile, which is likely to have little impact. One benefit of the medical form, which is 2-octyl cyanoacrylate (2-OC), is that it forms a bond about four times stronger than does butyl cyanoacrylate.

Advantages/Disadvantages

The advantages of using cyanoacrylate are: (a) it is easy to ...