Truss (medicine)
In medicine, a truss is a kind of surgical appliance, particularly one used for hernia patients. A truss provides support for the herniated area, using a pad and belt arrangement to hold it in the correct position.
Of historical interest, a variety of trusses are listed in the Snowden & Brother's catalog of the American Civil War era.[1]
Early versions of the hernia truss were daunting contraptions made from leather and steel with metal springs. The 19th century Eggleston's Truss from Chicago was described as follows:
"Eggleston's Truss has a pad different from all others. It is cup-shaped, with a self-adjusting ball in the centre, and adapts itself to all positions of the body, while the ball in the cup presses back the intestines just as a person does with the finger. With light pressure the hernia is held securely day and night, and a radical cure is certain. It is easy, durable and cheap." [2]
Later developments resulted in the Cluthe truss, described in Cluthe's Advice to the Ruptured, first published in 1912. This book also describes dozens of hernia cases which appeared to be cured by this relatively primitive truss. These cases are no longer considered to be scientific evidence, but are nevertheless encouraging testimonials for those with mild to moderate hernias who seek to follow the watchful waiting alternative to immediate hernia surgery.
Nowadays most doctors and surgeons do not prescribe trusses. Even some of today's trusses use metal springs to apply pressure to the hernia, via a pad which can be quite hard, and usually bulges into the hernia. This inward bulging prevents the edges of the hernia from coming together and could, in theory, enlarge the hernia. Many trusses also do not fit well. It is difficult to design a truss which keeps the pad permanently in contact with the hernia. Unless a truss can achieve this purpose, the hernia may continue to enlarge.
Recent statistics on the low-risk of inguinal hernia incarceration and the risk of long-term pain (inguinodynia) [3][4][5][6] [7][8][9] after herniorrhaphy (hernia repair surgery) suggest that trusses may soon come back into fashion.
[edit] References
- ^ Snowden; Weiss, John. Surgical and Dental Instruments Catalogues from the Civil War Era. Norman Publishing. ISBN 978-0930405724. http://books.google.com.au/books?id=Kvs1LtPO5EgC&pg=PR9&lpg=PR9&dq=history+%22surgical+instruments%22#PPA47,M1. Retrieved 2008-04-20.
- ^ Scientific American Vol 40 No. 13 March 1879
- ^ Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. Fitzgibbons RJ Jr, Giobbie-Hurder A et al. JAMA. 2006 Jan 18;295(3):285-92.
- ^ Tension-free repair versus watchful waiting for men with asymptomatic or minimally symptomatic inguinal hernias: a cost-effectiveness analysis. Stroupe KT, Manheim LM et al. J Am Coll Surg. 2006 Oct;203(4):458-68.
- ^ Inguinal hernias: should we repair? Turaga K, Fitzgibbons RJ Jr, Puri V. Surg Clin North Am. 2008 Feb;88(1):127-38.
- ^ Pain and functional impairment 6 years after inguinal herniorrhaphy.Aasvang EK, Bay-Nielsen M, Kehlet H. Section of Surgical Pathophysiology, The Juliane Marie Centre, 4074, Rigshospitalet, 2100, Copenhagen, Denmark. Hernia. 2006 Aug;10(4):316-21.
- ^ Chronic sequelae of common elective groin hernia repair. Loos MJA, Roumen RMH. Hernia (2007) 11:169–173.
- ^ Foreign body reaction to meshes used for the repair of abdominal wall hernias. Klinge U, Klosterhalfen B, Müller M, Schumpelick V. Eur J Surg. 1999 Jul;165(7):665-73.
- ^ Late-onset deep mesh infection after inguinal hernia repair. Delikoukos S, Tzovaras G, Liakou P et al. Hernia. 2007 Feb;11(1):15-7.
