Absorbable versus Non-Absorbable Sutures in Paediatric Facial Trauma - A Cosmetic Assessment

Paediatric age group is most vulnerable to trauma. Children often suffer facial injuries. Though many topical skin adhesives and strips are available in the market which have given excellent cosmetic results, deeper injuries especially along the lines of high tension need suturing both with buried and skin sutures. Different variety of sutures are available in the market which are used as per the choice of the surgeon. Children are more apprehensive when it comes to suture removal. So use of absorbable sutures in place of non-absorbable sutures in skin can save the children from this fear factor. MethodsA prospective study was done in the department of plastic surgery from May 2012 to Dec. 2013 with an objective of studying the outcome of plain catgut suture as skin sutures versus non-absorbable skin suture Nylon in facial trauma in the paediatric age group. Chromic catgut was used as buried suture in both groups. All the patients presenting in emergency department with facial trauma with age 10 years or less were included in the study. Skin sutures, where needed removal, were removed on 5th post-operative day followed by follow up on 7th post-operative day, 3rd month and 8th month during which cosmetic assessment of scar was done. 25 patients who presented first in emergency and fulfilled the study criteria were sutured with 5 - 0 chromic catgut buried sutures and skin suture used was 6 - 0 Nylon and this group was labelled group A. Next 25 patients who presented in emergency for suturing were sutured with 5 - 0 chromic catgut as buried and plain catgut as skin suture. This group was labelled as Group B. Cosmetic outcome was assessed on 7th post-operative day, 3rd month and 8th month by using Beusang E cosmetic scar assessment scale based on two parameters which included colour and texture of scar.1 Statistical analysis was done with continuous variables expressed as Mean ± S.D. and categorical variables were expressed as count (percentage). Chi-square was used to compare the categorical variables between groups or Fisher exact test was used. ResultsOn 7th post-operative day follow up, out of 50 patients, 25 patients (50 %) in whom nylon was used as skin suture, 4 patients (16 %) had mismatch of colour. All scars were smooth in texture. In rest 25 patients (50 %) in whom plain catgut was used as a skin suture, 1 (4 %) patient had mismatch of the colour. None of the patients had frank pus in both groups & hypertrophic scar was seen in one patient. On 3rd month follow up, Group A patients with nylon as skin suture, 1 (4 %) patient showed hypertrophic scar whereas in Group B (8 %) patients had hypertrophic scar. On 8th month follow up, both group A & B had colour mismatch of 12% with firm texture of scar in 8% patients. ConclusionsThere is no long-term differences in cosmetic outcomes and complication rates between absorbable catgut suture and commonly used nylon sutures in the repair of facial trauma in paediatric age groups. So, absorbable sutures are acceptable alternative to non-absorbable suture especially in paediatric age group, keeping in mind their apprehensive nature and fear of suture removal.

Polydioxanone as Buried Suture in Facial Trauma - A Prospective Study.

Irrespective of cause of injury, facial scars are always considered as a stigma causing both mental and social disgrace to the victim. The principle aim of any suturing is to produce aesthetically pleasing scar. Besides surgical skills, the choice of suture material also plays a very important role in getting a good scar. Though suture material used for suturing is mostly Nylon everywhere, it’s the buried sutures which obliterate the dead space and reduce wound tension which make the real difference in the appearance of scar. Sutures of different types are today available & the operating surgeon uses the best suture material for the patient in a given circumstance based on his personal experience, scientific observations, & manufacturer’s advice.1 METHODSThis is a prospective study conducted in the department of plastic surgery at Christian Medical College, Ludhiana from May 2012 to April 2013. The study included all the patients of facial trauma registered during that period of one year. Demographic profile was noted along with the cause of trauma. A well-informed consent was taken. In our study skin approximation was done by either 5-0 or 6-0 Nylon suture. Buried suture used in all was Polydioxanone (PDS) 5-0. Skin sutures were removed on 5th POD. Beusang Clinical Scar assessment scale2 was used in the study to assess scar appearance. Patients were followed every month for 5 months after removal of skin sutures. The parameters noted included, colour, contour, matte/shine, and texture of scar. Photographic record of the patients was maintained. Statistical analysis was done using McNemar test. RESULTSOut of the 40 patients in our study, road traffic accidents constituted 85 percent of facial trauma, rest included fall on floor. M:F ratio was 3:1. With Polydioxanone as buried suture, 35 patients (87.5%) had normal texture, 30 patients (75%) had Matte appearance of the scar, 20 patients (50%) had no distortion of scar, 25 patients (62.5%) had perfect match of colour with hypertrophic scar noticed in 4 patients (0.1%). CONCLUSIONSPolydioxanone as buried suture gave aesthetically pleasing scar which improved in appearance during the follow up periods. There was significant statistical improvement in scar appearance starting from 5th day of suture removal to assessment at 5 months. No discharge from the wound site was noted in any of the patients. Hypertrophic scars noticed were later treated with steroid injection

The New Method of Double Fold Operation Using Hybrid Technique: Combined Incisional and Non-incisional Method

BACKGROUND: Double-fold operation is one of the most common types of surgery in Korea and can be divided into two major surgical techniques, incisional and non-incisional methods. Each method has its own advantages and disadvantages. Therefore, the author describes a new procedure to take advantage of both methods. METHODS: This procedure was performed in 127 consecutive patients (106 primary cases, 21 secondary cases) whose ages ranged from 19 to 65 years. First, a double-fold was made using the non-incisional method, and then excessive fat and redundant skin were removed using the incisional method. Fat was removed if necessary. For patients with blepharoptosis, before removing the redundant skin, this condition was corrected with the non-incisional Muller tucking ptosis method. RESULTS: Of the 127 patients, 122 patients were satisfied with the result. Edema and scarring were less than with the incisional method, and the postoperative result was easier to predict than with the secondary double-fold operation. Three cases had shallow eyelid lines, and one case had a complete loss of the fold. One secondary case patient had asymmetry that was corrected with revision. CONCLUSIONS: Because satisfactory results can't be achieved easily with the double-fold operation, a challenge for plastic surgeons is choosing the best method for the double-fold operation, especially in secondary cases. This new method that uses a hybrid technique that combines the incisional and non-incisional methods may be an effective choice when performing the double-fold operation in both primary and secondary cases.

Application of mini-incision combined with buried suture in double eyelid plasty / 中华医学美学美容杂志

Objective To explore the advantage of the mini-incision doubling eyelid operation comparied with buried suture method.Methods 201 single eyelid cases were randomly divided into 2 groups:group A(101 cases)using mini-incision doubling eyelid operation,and group B(100 cases)using the double eyelid plasty with buried suture.Their effect was comparied.Results 157 cases were received postoperative follow-up.Group A(81 cases)contained 45 thin eyelids and 36 thick eyelids.Group B(76cases)included 32 thin eyelids and 44 thick eyelids.The postoperative follow-up for 1 month revealed that there was no statistically significant difference in the rate of satisfaction between group A and group B among the thin eyelid patients(P＞0.05).But statistic difference was found between A and B group among the thick eyelid patients(P＜0.05).The follow-up period for group A and group B was in the range of 2.5 to 3.5 years.The maintenance-well rate between the thin eyelid and the thick eyelid patients in both groups was significantly different(P＜0.05).Conclusion The mini-incision doubling eyelid operation is superior to the double eyelid plasty with buried suture in the rate of postoperative satisfaction and long-term effect.It is deserved to have more applications.

Rectification of inverted nipple by double buried purse-ring suture / 中华医学美学美容杂志

Objective To introduce a simple, effective and less wounded approach to rectify an inverted nipple. Methods Patients lian down in a horizontal position, two circles were drawm in diameters of 2.5 cm and 3.5 cm, respectively, in the centre of nipple. Routine disinfection and local anaesthesia were performed, a small incision in 0.3 cm was cut around inner and outer circular arc each, and then # 4 and # 7 threads were buried, respectively, under inner and outer cycles of skin. The inverted nipple was lifted by crossing those two threads, tying # 4 and # 7 thread (not so strong), and finally incisions were sewn by 5.0 thread. 7 days later, stitches were removed but no extrusion done within 3 months after surgery. Results Lactation was normal, and nipple and mammary areola were satisfied by patients. Conclusion The main cause of inverted nipple is imbalance growth for nipple and mammary areola muscle, and lack of tissue to support under nipple. Using double buried purse-ring suture, it is not only strong the nipple root, and block the gap when nipple is retracting, but also make nipple be beautiful and does not affect lactation. It is an easy and useful operation, with less damage to normal tissues and quick recovery.

Double Eyelid Operation Using Continuous Buried Suture Method Avoiding Conjunctival Injury by a Newly Made Chalazion Forcep

Nowadays, nonincisional double eyelid operation is preferred by lots of patients and surgeons. There are a variety of suture methods but all the suture procedures-including continuous buried suture methods-in the literatures penetrate the conjunctivas. So due to the pain, surgeons had to infiltrate local analgesics into the conjunctiva. This horrifies the patients, gives pain, makes the eyelids and conjunctivas swollen, and sometimes interrupts the movements of the eyelids by affecting the levator palpabrae muscles. This condition could make the eyelid folds asymmetric. Authors changed the procedure by using a chalazion forcep with a small slit which allows the suture materials to get out and we could successfully perform the suture without penetrating the conjunctiva. So we could make double folds maintaining the patient's dynamic and static conditions very well since no direct local analgesics were needed for the conjunctivas, and the results were pretty satisfactory.

Double Eyelid Operation in Middle-aged Women by Buried Suture Method

Double eyelid operation is the most common cosmetic surgery in Asian. There are two procedures for the double eyelid operation: one is an incision method and the other is a suture(non- incision) method. The latter is classified into two categories: stitch method and buried suture method. The popular indications for the non-incision method are listed below (1) A dislike is shown for a procedure that may possibly leave conspicuous scars. (2) The relaxation of the skin and orbicular oculi muscle is not strong, and they retain some tension. (3) The deposition of subcutaneous fat is not very heavy. (4) A wide double eyelid line is not desired. (5) A weak double eyelid line is already present. So the plastic surgeon generally offer the incision method when the patient is older than the age of 35. But rarely aged woman wants the double eyelid operation by non-incision method because of short recovery time and less scar. From December 1999 to June 2003, we performed the double eyelid operation by non-incision method in 22 patients who are older than the age of 40 with selective indications. 16 patients (72.73%) were satisfied with their aesthetic results.

Double Eyelid Operation Using Partial Incision and Continuous Buried Suture

e double eyelid operation is one of the most common aesthetic operation in Korea. The non-incision method have advantage such as decreased swelling, faster recovery and so forth. However difficulties arise in case of excessively fatty upper eyelids. The authors have devised a method for use with the fatty upper eyelid. Through the partial incision, orbital fat was removed and the double fold was made with the continuous buried suture technique. This technique was performed in 215 cases in 462 total double eyelid operation in Metro Plastic Surgery Clinic from August 2000 to May 2002. We experienced satisfactory results in all cases except 1 case of asymmetry and 1 case of fold loss. The authors conclude that this method achieves a shorter operation time, less morbidity and better cosmetic results in fatty upper eyelids than the other incision methods.

Modified Continuous Buried Suture Technique for Upper Lid Epiblepharon

PURPOSE: To evaluate the effectiveness and complication rate of our modified continuous buried suture technique for the correction of the upper lid epiblepharon. METHODS: This retrospective study included 132 eyes of 66 patients, who were diagnosed with upper lid epiblepharon from March 2000 through April 2002 After the followup of over 6 months, we evaluated the improvement and recurrent rate of epiblepharon after the procedure. RESULTS: In 131 of 132 eyes with the mean followup period of 12.9 months, the epiblepharon was corrected successfully with cosmetically satisfactory Results. In 1 eye, we experienced the disappearance of a double fold without the recurrence of the epiblepharon. CONCLUSIONS: This modified continuous buried suture Method appears to be an effective treatment of lash inversion in upper lid epiblepharon with good aesthetic Results.

Double Eyelid Operation using Subconjunctival Buried Suture Method

Double eyelid operation is one of the most common aesthetic surgical procedure performed in Korea. In correlation with the cultural background and social changes, most patients prefer a nonincision method rather than an incision method at the present. Forty-two consecutive patients were operated on for creation of double eyelids, with the subconjunctival buried suture method through conjunctival approach, from June of 1999 to September of 2000. The choice of procedure was based on the age of the patient and the amount of subcutaneous fat and redundant skin. This method was especially advisable if the young patient wants not to leave any visible scar and rapid recovery. The follow-up period ranged from two months to one year. Of forty-two patients undergoing this procedure, three patients(7.1%) required reoperation because of asymmetry, disappearance of fold, and irrtation respectively. This method is similar to various ordinary nonincisional methods previously described except for subconjunctival buried suture. But authors could obtain better cosmetic result with the advantage of shorter operation time, less morbidity, no scarring, and natural look earlier in the appropriate candidates.

Various clinical applications of the continuous buried suture method: non-incision double eyelid operation

The double eyelid operation is one of the most common cosmetic surgery performed in orientals, and there are numerous studies about surgical procedures of that. In the case of appropriate candidates, the non-incision technique makes excellent cosmetic results, with the advantages of shorter operating time, less morbidity, less pain, no scarring and easy revision of shape. But, usually the non-incision technique is recommended in the cases with thin upper eyelid, small amount of orbital fat, less redundant skin of upper eyelid and in whom a wide fold is not desired so on. Therefore, the disadvantages of this method are that it cannot be applied to all patients. The postoperative complications are disappearance or faded fold, formation of cyst or lumps, asymmetry etc. and the incidence of these complications is slightly higher than those of the incisional method. In this study, the double eyelid operation using the continuous buried suture method was performed in 210 patients for formation of double eyelid from Jan. 1993 to Dec. 1995. In conclusion very good results can be obtained by the continuous buried suture method even in the cases of puffy upper eyelid. This method can make a double eyelid shape in the fashion the patient wants and can be a new indication for correction of unilateral double eyelid. This method is safe, satisfactory and take shorter postoperative recovery time and it can reduce the incidence of postoperative complications.