Is it just me, or does that guy really suck at suturing? I'm not a physician (never even played one), but I've watched instructional videos, and that didn't look like how the pros do it. The pros can suture and tie a knot way faster. If you suture like that then obviously glue would be better!
I felt really bad for whatever mammal that was (dog? rabbit?), especially because of the suturing job..
FWIW, the animal did appear to be adequately anesthetized as it did not flinch with the incision or suturing, and, no, he was not good, he barely knew what he was doing:
- wrong scalpel. That was a 10 blade used for long linear incision (e.g. > 10-40 mm). He should have used an 11 or 15 blade which are smaller and better suited to precision cuts, which these were not - he hacked at the skin instead if cleanly incising (so the technique was bad, the blade was dull, and he used the wrong blade).
- he did not use a pair of forceps to grasp the skin putting him self at risk of a needle-stick injury.
- needle entry was not perpendicular to the skin
- he used PDS suture (it looked purple) , which is _never_ used on skin (especially externalized). Prolene is used for an external knot, or vicryl or monocryl for a subcuticular suture
- the suture looks to be a 3-0 or 4-0....that's what I would use to close an adult human (5-0,which is smaller, for the face). Should probably be using 5-0 or 6-0 here. Then again, this guy would probably break that suture since he doesn't have the manual dexterity or technique.
- he should have used a horizontal or 2 vertical mattress sutures to close the defect, not a single simple suture
- he didn't tie square knots and his tying was worse than a medical student's (who don't know how to suture either)
So I may just be nitpicking but, then again, that's what I do as an academic surgeon who trains upcoming surgeons.
But to actually address the article: It looks promising. I have questions about:
A) potential toxicity (nanoparticles can behave in less predictable way in-vivo) [large volumes of iron can be toxic to the body hemosiderin leading to iron overload], also silica is sometimes not well tolerated by the body
B) I would like to see this applied in a larger model (porcine would be good), with a large volume hemorrhage (analogous to a human GSW or stabbing wound) to see if the tensile strength of this seal scales up and to see if a large volume of blood will wash it away rendering it useless.
C) Does it withstand the detergent like properties of bile?
D) What percentage of normal tensile strength does this technique afford? Sutures physically hold tissue together to prevent separation under shear stress - how much strength does this stuff afford?
E) Does the substance affect normal wound healing (scar tissue is a normal, appropriate response, in an adult, to tissue injury; less scar may mean abnormal or poorer wound healing)
F) Will it be scalable (yes you can produce it in a lab easily enough, but can you make medical grade easily?)
G) Can it cause injury to adjoining tissue? The edge of the wound is hypoxic (low oxygen concentration), will this be toxic to these at risk tissues?
It is a long way from the lab to clinical use, but this appears promising. Look forward to seeing how the technology plays out. And no....it won't put me out of a job, but if it works out it may make my job easier and give better outcomes.