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Objective@#To investigate the clinical effect of the combination of distal subcutaneous buried suture, to reduce local tension, and electron irradiation for the treatment of keloid.@*Methods@#From May 2014 to July 2016, nine female patients with recurrent keloid in torso were treated by above method. After eligibility was confirmed, surgery was performed to completely excise the keloid. An extensive subcutaneous segregation was made around the incision. The 4-0 PDS Ⅱ sutures were buried in the subcutaneous layer, 1.5 cm from the edges of incision, 1 cm apart from each other, and were knotted from both ends of the incision to the center. The normal skin on both sides of the incision were pulled toward the center, and completely relaxed without tension. An interrupted subcutaneous suture was made with a 4-0 Coated VICRYL absorbable suture, and a continuous intradermic suture was made using a 5-0 Coated VICRYL absorbable suture. Superficial electron irradiation was implemented 10-22 h postoperatively. The dose of radiation was 4 Gy each time, with the frequency of 4-5 times in 4-7 days, once a day, and the total dose was up to 16-20 Gy.@*Results@#The average follow-up was 15 months (12-18 months). Based on the three-stage classification system formulated by Dr. Cai, an asymptomatic flat and soft scar without recurrence up to 12 months was classified as cured (excellent). All the patients in this series met the criterion of cure.@*Conclusions@#The distal subcutaneous buried suture technique, pulling bilateral normal skin toward the center with a PDS Ⅱ suture, could completely relax the skin around the incision, and maintain a prolonged tension-free state, combination therapy of electron irradiation and surgery may reduce the inflammation during the healing process, and result in a dramatic inhibition of the recurrent of keloids after surgery.
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Objective To study the repairing skull defect postoperative scalp raw muscle necrosis application as the clinical treatment of skin cream and tension suture technique.Methods A retrospective analysis of 26 cases of skull defect postoperative scalp necrosis in June 2007 to June 2014 was recorded.Given the tension suture after surgical debridement suture with raw muscle elephant skin creams besmear in the treatment of wounds.Results Twenty-four cases of scalp necrotic wounds healing,1 case was given after the repair material from the scalp necrotic wounds healing,1 case of secondary intracranial infection,given the repair material from brain abscesses clear postoperative wound healing.Conclusion Adopting the raw flesh like a skin cream for the treatment of tension suture after surgical debridement,can achieve rapid cure local infection,promote the healing of the scalp necrotic wounds,reduced the skull to operation failure and postoperative scalp defect repair necrosis repair material from risk,obtain ideal treatment effect.
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PURPOSE: The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The most common complication of LD muscle flap is donor site seroma, reported to occur in 20 to 79 percent of cases. The formation of dead space under the flap is intimately associated with seroma formation. The authors think that the use of progressive tension suture at closing donor site can decrease the formation of dead space and ultimately reduce the incidence of donor site seroma. METHODS: A retrospective review was performed with 38 patients who underwent latissimus dorsi muscle harvest for breast reconstruction from March 2003 to September 2004. Progressive tension sutures were used during donor site closure in 22 patients. This group was compared with controls group(16 patients) who underwent latissimus dorsi muscle harvest without using this technique. Operation time, length of hospital stay, period of drainage, complication, and satisfaction about postoperative scar of donor site were examined. RESULTS: The average length of hospital stay was 10.2 days and 12.7 days, and the mean duration of drainage were 7.3 days and 11.7 days in each progressive suture group and control group. These results were statistically significant (p<0.05). In the 22 patients who underwent progressive tension suture, none had seroma, hematoma or skin necrosis. In control group(16 patients), there happened one seroma formation and one partial skin necrosis. These complications were healed by aspiration of seroma and wound revision. The patients' satisfaction was not statistically significant, but the higher points were given by the patients who underwent progressive tension suture. CONCLUSION: This technique, progressive tension suture, is an effective method to reduce or eliminate donor site seroma, which is the most common complication associated with latissimus dorsi muscle harvest.