Closure pearls for defects under tension

[Application of Zunyi's Suture Method for donor site of anterolateral thigh flap]

OBJECTIVE

To investigate the effectiveness of multiple tension reduction suture of in-situ return needle vertical mattress suture and in-situ return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi's Suture Method) on suturing the donor site of the anterolateral thigh flap.

METHODS

Between January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). The size of anterolateral thigh flap ranged from 6 cm×5 cm to 25 cm×7 cm. The donor site of the flap was sutured directly by the Zunyi's Suture Method. The skin on both sides of the incision was advanced to the middle, and the wound edge was attached and in a state of negative tension. The intradermal suture line was removed at 7 days after operation. The complications and scars at donor site were observed during follow-up. The Vancouver Scar Scale was used to assess the appearance of scars and the width of scars were measured at 6 months after operation.

RESULTS

The flaps survived smoothly, and the wounds healed by first intention. The incisions at donor sites healed by first intention at 2 to 3 weeks after operation. All patients were followed up 7-16 months, with an average of 10.7 months. There was no ischemic necrosis of the donor site or skin threading. There was pigmentation of the needle back point in the early stage, and the pigmentation completely disappeared after 3 to 6 months without scar hyperplasia. At 6 months after operation, liner scars were achieved in all the patients with an average Vancouver Scar Scale score of 2.5 (range, 1.0-3.5) and an average width of 2.4 mm (range, 0.8-9.1 mm).

CONCLUSION

The suture of the donor site of the anterolateral thigh flap with Zunyi's Suture Method can effectively reduce the tension on wound edges and scar hyperplasia.

Scalp Closures With Pulley Sutures Reduce Time and Cost Compared to Traditional Layered Technique-A Prospective, Randomized, Observer-Blinded Study

BACKGROUND

Reconstruction of postsurgical scalp defects can be difficult and time-consuming using a conventional bilayered technique. A specialized closure using a pulley suture can assist in closing wounds under high tension and can decrease time and cost for the surgeon.

OBJECTIVE

To determine if closing scalp defects with a single-layered closure using pulley sutures would result in decreased time but equivalent scar cosmesis compared to bilayered closures.

MATERIALS AND METHODS

A total of 21 patients with postsurgical scalp defects were randomized to a bilayered or a pulley group, and time was measured for each closure. Scar appearance was assessed using the Patient and Observer Scar Assessment Scale at 2 weeks, 2 months, and 6 months postsurgery. Before and after photographs were also assessed by a blinded dermatologist using the visual analog scale.

RESULTS

Compared to a bilayered closure, the pulley technique resulted in significantly reduced closure time (p < .001). Even though patient overall scores at 2 weeks and observer total score at 6 months were superior in the pulley group, the visual analog scale scores were similar between the 2 groups.

CONCLUSION

Scalp reconstructions using a single layer of pulley sutures result in time and cost reduction and similar scar appearance compared to bilayered closures.

Sutures, needles, and tissue adhesives: a review for dermatologic surgery

BACKGROUND

Dermatologic surgery generally requires the removal of offending or excessive tissue followed by repair of the resultant defect. The functional and cosmetic outcome is increasingly important as patients' expectations grow and physicians become increasingly aware of surgical materials and techniques that enable them to repair defects in a functionally and cosmetically appealing manner.

OBJECTIVE

To perform an updated and thorough review of the literature regarding sutures, surgical tape, tissue adhesives and stitching techniques.

MATERIALS AND METHODS

A comprehensive literature review was conducted on-line via multiple search engines and sites using the keywords suture, suture techniques, suturing techniques, surgical techniques, surgical tapes, surgical adhesives, and tissue adhesives.

RESULTS

There are numerous articles on sutures, surgical tape, and tissue adhesives, but there are no current articles that review them together in a comprehensive manner and combine the review with a discussion of stitching techniques.

CONCLUSION

Suture choice and surgical and stitching techniques may be guided by the TAFT concept of wound closure that recognizes the main function of suture and closure devices: Tension relief; Apposition enhancement; and surface Finishing Touches. The dermatologist's goal is to create functionally and aesthetically pleasing scars for optimal patient satisfaction, which is of ultimate importance considering that the scars patients receive leave a lasting impression of their dermatology experience.