The immediate use of a silicone sheet wound closure device in scar reduction and prevention.

Silicone has been used successfully postoperatively in the prevention of hypertrophic and other types of adverse scars. The Silicone Suture Plate (SSP) is a new, minimally invasive, sterile wound closure device that is applied intraoperatively to prevent adverse scarring. The SSP device permits immediate application of silicone while concurrently allowing for wound-edge tension redistribution. In this prospective, controlled, single-blinded clinical study, 8 consecutive patients undergoing deep-plane rhytidectomy were selected. SSP devices were placed on the patients' posterior rhytidectomy hairline incision; the mirror-image control site underwent standard suturing techniques. Three blinded, independent raters assessed the treatment and control sides at 6-week and 4-month follow-up visits, using the Objective Scar Assessment Scale (OSAS), a validated scar assessment tool. The 6-week OSAS scores revealed an 18.4% improvement on the side with the SSP device (13.3) when compared to the control side (16.3). The 4-month OSAS scores showed a 27.3% improvement on the treatment side from 12.7 (control) to 9.2 (SSP). These OSAS results were found to be statistically significant when taken as an aggregate of the observers' scores, but not when observers' scores were measured individually (p < 0.05). In our series of patients, we showed promising results with the use of the SSP device. Early silicone application and tissue tension distribution contributed to an overall more aesthetically pleasing scar compared to those seen with standard suturing techniques, although more testing is required.

The use of fibrin glue for fixation of acellular human dermal allograft in septal perforation repair.

OBJECTIVES: Acellular human dermal allograft used as an interpositional graft between mucoperichondrial flaps has been shown to be effective in the repair of septal perforations. The material is typically sutured to the septum, but this can be technically difficult. We describe a technique in which fibrin glue is used to secure the acellular human dermal allograft for septal perforation repair. STUDY DESIGN: A retrospective case series of 5 patients who underwent this procedure are reviewed. METHODS: Five patients with preexisting septal perforations underwent septal repair using fibrin glue to secure the interpositional acellular human dermal allograft. The graft was first placed between the mucoperichondrial flaps, and 1/3 cm(3) of fibrin glue was applied to both sides. One side was then covered with a bipedicled mucosal flap and compressed for 5 minutes to allow for fixation. RESULTS: The use of fibrin glue compared with conventional suturing decreased the length of the procedure by approximately 30 minutes. At the 3-month postoperative examination, all 5 patients were found to have successful outcomes. CONCLUSION: The use of fibrin glue for fixation of the acellular human dermal allograft in septal perforation repair is technically less difficult and reduces the length of the procedure, and we believe it reduces graft migration when compared with conventional suturing techniques.