A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut versus Nonabsorbable Nylon Sutures

Patient and Observer Graded Rhinoplasty Scar Outcomes: A Randomized Controlled Trial of Fast Absorbing Versus Permanent Columellar Suture Closure

Background: When performing an open rhinoplasty, surgeons commonly use nonabsorbable skin sutures to close the columellar incision. These are believed to minimize scarring. However, removal can be associated with patient discomfort and outcomes may not be superior to using absorbable sutures. Objective: To compare difference in scar appearance for columellar closure after rhinoplasty with absorbable and nonabsorbable sutures. Methods: We performed a prospective randomized control trial with 61 patients. Forty-one patients completed follow-up and were included in final analysis: 23 whose columellar incision was closed with absorbable sutures and 18 with nonabsorbable sutures. A blinded surgeon performed Stony Brook Evaluation Scale (SBES) and a patient performed Patient Scar Assessment Questionnaire (PSAQ) was completed for each suture type. Results: Our results did not reject the null hypothesis that there is no difference in SBES or PSAQ scores between absorbable and nonabsorbable suture types. Conclusions: No difference was detected in scar outcomes between absorbable and nonabsorbable sutures for closure of the columellar incision created during an open rhinoplasty as rated by both patients and blinded clinicians.

Surgical wounds in reduction mammoplasty: a comparison of Monocryl and Prolene sutures on scars

OBJECTIVE

The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars.

METHOD

A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study.

RESULTS

Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery.

CONCLUSIONS

Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty.

Absorbable Versus Non-Absorbable Sutures in Open Rhinoplasty: A Comparative Analysis of Columellar Scarring

INTRODUCTION

Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons.

OBJECTIVE

This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons.

MATERIAL AND METHODS

Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs.

RESULTS

Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05).

CONCLUSIONS

Absorbable sutures are a convenient alternative to nonabsorbable sutures.

LEVEL IV

Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

The effect of different suturing materials for abdominal fascia wound closure on the collagen I/III expression ratio in rats

Background

Incisional hernia is a frequent complication of abdominal wall incision and has a high rate of recurrence. Most of the studies stated that non-absorbable sutures decreased incisional hernia incidences, but some stated otherwise. We aimed to compare the collagen type I/III ratio between monofilament non-absorbable sutures and multifilament absorbable sutures for abdominal fascia closure in Wistar albino rats.

Methods

Forty rats were divided into four groups. Groups 1 and 3 were sutured with monofilament non-absorbable (polyvinylidene fluoride). Groups 2 and 4 were sutured with multifilament absorbable (polyglycolide). Then, groups 1 and 2 were euthanized on day 4 (POD 4), while groups 3 and 4 were euthanized on day 7 (POD 7). Samples of fascia (1 × 0.5 cm) were taken for analysis. Collagen I/III ratios were measured using immunohistochemistry staining methods.

Results

While the expression of collagen I was not significantly different between monofilament non-absorbable and multifilament absorbable at POD 4 and 7 (p = 0.45 and 0.81, respectively), the expression of collagen III reached a significant level with p-values of 0.0003 and 0.0004 for POD 4 and 7, respectively. Moreover, the collagen I/III ratio was also significantly different between the two groups either at POD 4 (0.88 ± 0.23 vs. 0.53 ± 0.08; p = 0.0003) and 7 (1.77 ± 0.65 vs. 1.03 ± 0.28; p = 0.004).

Conclusions

Monofilament non-absorbable sutures show a significantly higher collagen I/III ratio than multifilament absorbable sutures for abdominal fascia closure in rats. Our findings imply that the usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence.

•

One of the most important factors that influences the occurrence of incisional hernia is suturing material.

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Collagen is a major component of the extracellular matrix and plays an important role in maintaining tissue elasticity and tensility.

•

The usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence.

Comparison of Rapid Absorbable Sutures with Nonabsorbable Sutures in Closing Transcolumellar Incision in Septorhinoplasty: Short-term Outcomes

BACKGROUND

Following open rhinoplasty, a postoperative scar at the columellar incision line is a common morbidity. The aim of this study is to compare absorbable and nonabsorbable suture materials which had been used for closing the transcolumellar incision, in the aspect of risk of postoperative infection, wound healing, postoperative columellar scar and patient satisfaction.

METHOD

A prospective, randomized, single-blind study was conducted between May 2017 and February 2018. Sixty-four rhinoplasty patients were randomly assigned to absorbable (n = 32) or nonabsorbable (n = 32) groups. The columellar incision was closed with 7 full-thickness skin sutures. Either nonabsorbable 6/0 polypropylene (Group 1) or absorbable 6/0 polyglytone 6211 (Group 2) sutures were placed at the columellar incisions. Polypropylene sutures were removed at the 7th postoperative day. A Mann-Whitney U test and Monte Carlo were used for statistical comparison. Photographs of the patients at the postoperative third month (Fig. 2) were evaluated and scored in terms of scarring, pigmentation, notching, level differences in the incision area by two different otorhinolaryngologists who did not know the randomization. Suture removing discomfort was assessed with visual analogue scale scores. A satisfaction survey was filled out by all the patients completing their third month after the operation.

RESULTS

According to the results of both otorhinolaryngologists, there was no significant difference between the two groups in terms of pigmentation, level difference, notching, overall appearance and total score (p = 0.920, p = 0.498, respectively). The mean score on the Wong-Baker scale was 3.19 ± 1.67 in group 1. In the Satisfaction Survey, the average score of the group 1 was 6.90 ± 3.24, while the mean score of the group 2 was 7.062 ± 2.77. There was no statistically significant difference between the two groups (p = 0.715).

CONCLUSIONS

Suturing inverted V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to nonresorbable sutures as evaluated by patients and observers.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Catgut and its Use in Plastic Surgery

The aim of this paper is to review the origin, physical properties, advantages, and usage of catgut in plastic surgery and oral surgery.In PubMed search, the search terms ("catgut" AND ["plastic surgery" OR "facelift"]) and ("catgut" AND "oral surgery") were used, resulting in 28 and 30 papers, respectively. Of those 58 papers, 31 papers were excluded. Eight other papers were added; therefore, 35 papers were analyzed.Catgut has been used in cleft palate surgery since 1938. In 1976, it was used in a superficial wound with anti-tension taping. In the 1970s, 1980s, and 1990s, catgut was used in otoplasty, scrotoplasty, hemostasis of neurofibroma, blepharoplasty, ptosis surgery, and rhytidectomy. From the 2000s until the present day, it has been preferred in many fields of plastic surgery, including pediatric lacerations and conjunctiva sutures. In oral wound repairs and tonsillectomy, catgut has been used from the 1970s to the present. Many studies have compared catgut with other suture materials in terms of wound healing, inflammatory reaction, and longevity, and their respective advantages and disadvantages continue to be discussed.The advantages of catgut as a suture material are as follows: 1, The fundamental advantage of catgut is its absorbability. 2, Catgut has excellent tensile strength. 3, Sterility, when catgut is taken from a sealed tube, is assured. 4, Hardened, or 'chromed,' catgut is preferable to the 'plain' variety. 5, The finest possible size should be used in preference to thicker sizes.Catgut sutures are still widely used in plastic surgery and oral surgery.

Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures

Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.

La gestion de la douleur et de l’anxiété chez les enfants lors de brèves interventions diagnostiques et thérapeutiques

Les interventions médicales courantes utilisées pour évaluer et traiter les patients peuvent causer une douleur et une anxiété marquées. Les cliniciens devraient adopter une approche de base pour limiter la douleur et l’anxiété chez les enfants, notamment à l’égard des interventions diagnostiques et thérapeutiques fréquentes. Le présent document de principes est axé sur les nourrissons, les enfants et les adolescents qui subissent des interventions médicales courantes mineures, mais douloureuses. Il n’aborde pas les soins prodigués à l’unité de soins intensifs néonatale. Les auteurs examinent des stratégies simples et fondées sur des données probantes pour gérer la douleur et l’anxiété et donnent des conseils pour en faire un volet essentiel de la pratique clinique. Les professionnels de la santé sont invités à utiliser des façons de procéder peu invasives et, lorsque les interventions douloureuses sont inévitables, à combiner des stratégies simples de réduction de la douleur et de l’anxiété pour améliorer l’expérience du patient, du parent et du professionnel de la santé. Les administrateurs de la santé sont encouragés à créer des politiques pour leurs établissements, à améliorer la formation et l’accès aux lignes directrices, à créer des environnements propices aux enfants et aux adolescents, à s’assurer de la disponibilité du personnel, de l’équipement et des agents pharmacologiques appropriés et à effectuer des contrôles de qualité pour garantir une gestion de la douleur optimale.

Making better wound management decisions

Clinicians make wound management decisions based on scientific research of varying quality as well as personal and observed habits, anecdotal evidence, and even misinterpreted data. This article examines some common traumatic wound management topics and discusses appropriate decision-making for wound management.

Laceration Management

BACKGROUND

Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.

OBJECTIVE

Innovations in laceration management have the potential to improve patient experience with this common presentation.

DISCUSSION

Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.

CONCLUSIONS

Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.

Absorbable Versus Nonabsorbable Sutures for Skin Closure: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Prior studies focused on skin closure using absorbable or nonabsorbable sutures involved small samples and produced conflicting results. The optimal method of skin closure still remains unclear.

OBJECTIVE

This study aimed to compare the outcomes of absorbable versus nonabsorbable sutures for skin closure.

METHODS

A meta-analysis was performed in randomized controlled trials (RCTs) that compared outcomes of absorbable versus nonabsorbable sutures for skin closure.

RESULTS

A total of 1748 patients in 19 RCTs were analyzed. There was no significant difference between absorbable sutures and nonabsorbable sutures in the incidence of wound infections, cosmetic outcomes, scar formation, wound dehiscence, and patients' or patient caregivers' satisfaction. Better cosmetic results were achieved by using intradermal absorbable sutures compared with nonabsorbable sutures in subgroup analysis, but this result might be affected by insufficient follow-ups.

CONCLUSIONS

Absorbable sutures for skin closure were not inferior to nonabsorbable sutures. It should be recommended due to its great cost and time savings. Well-designed RCTs with sufficient follow-ups are needed to adequately clarify whether better cosmetic results can be achieved using intradermal absorbable sutures.

Rapid Resorbable Sutures Are a Favourable Alternative to Non-resorbable Sutures in Closing Transcolumellar Incision in Rhinoplasty

BACKGROUND

The open approach using inverted-V incisions has gained popularity in both primary and revision rhinoplasty during the last years. The risk of a disturbing columellar scar has been shown to be very low when meticulously closed. However, the suture extractions are usually painful and time consuming.

OBJECTIVES

To investigate if rapid resorbable sutures could replace non-resorbable sutures in nasal transcolumellar incisions. The present study compared (1) patient discomfort, (2) scarring and (3) risk for postoperative infection.

MATERIALS AND METHODS

A total of 58 consecutive patients subjected to open rhinoplasty by the same surgeon using midcolumellar inverted-V incisions were investigated retrospectively. Forty-one (71 %) were eligible and investigated, of whom 27 (65 %) were of Middle Eastern descent and the rest Caucasians from Northern Europe. The first 21 patients were sutured with non-resorbable suture material polypropylene (PP) (Prolene(®) 5/0; Ethicon Inc.) and the subsequent 20 patients with a rapidly resorbable suture material, the 5/0 irradiated Polygalactic acid (PGA); (Vicryl Rapide(®) 5/0; Ethicon Inc.). Discomfort from the suture extraction of the PP sutures was compared to trimming of the PGA sutures at the skin surface 1 week postoperatively, and visibility of the columellar scars was evaluated by the patients themselves on a self-report questionnaire. This was done prior to the investigation and postoperative photography at the follow-up visit a minimum of 6 months postoperatively. The postoperative photographs were then assessed by 20 rhinoplasty surgeons independently, using the same questionnaire.

RESULTS

Trimming of the PGA sutures caused significantly less discomfort than the extraction of PP sutures (p ≤ 0.01), of which 6 (29 %) found the suture extraction very painful. Overall, 40/41 (98 %) found their scars non-disturbing. Moreover, 17/21 (81 %) of the patients sutured with PP and 18/20 (90 %) of the patients sutured with PGA considered their scars to be invisible or almost invisible. The corresponding assessments from the observers were 16/21 (76 %) and 16/20 (80 %), respectively. No postoperative infection was found in any group.

CONCLUSION

Suturing inverted-V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to non-resorbable sutures as evaluated by patients and observers.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Continuous versus interrupted skin sutures for non-obstetric surgery

BACKGROUND

Most surgical procedures involve a cut in the skin, allowing the surgeon to gain access to the surgical site. Most surgical wounds are closed fully at the end of the procedure; this review focuses on these closed wounds. There are many ways to close the surgical incision, for example, using sutures (stitches), staples, tissue adhesives or tapes. Skin sutures can be continuous or interrupted. In general, continuous sutures are usually subcuticular and can be absorbable or non-absorbable, while interrupted sutures are usually non-absorbable and involve the full thickness of the skin - although some surgeons do use absorbable interrupted sutures.

OBJECTIVES

To compare the benefits and harms of continuous compared with interrupted skin closure techniques in participants undergoing non-obstetric surgery.

SEARCH METHODS

In August 2013 we searched the following databases: Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL.

SELECTION CRITERIA

We included only randomised controlled trials (RCTs) that compared skin closure using continuous sutures with skin closure using interrupted sutures, irrespective of whether there were differences in the nature of the suture materials used in the two groups. We included all relevant RCTs in the analysis, irrespective of language of publication, publication status, publication year or sample size.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified the trials and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups, and calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We performed meta-analysis using a fixed-effect model and a random-effects model. We performed intention-to-treat analysis whenever possible.

MAIN RESULTS

We included five RCTs with a total of 827 participants. Outcomes were available for 730 participants (384 participants randomised to continuous sutures and 346 participants to interrupted sutures). All the trials were of unclear or high risk of bias. The participants underwent abdominal or groin operations. The only outcomes reported in the trials were superficial surgical site infection, superficial wound dehiscence (breakdown) and length of hospital stay. Other important outcomes such as quality of life, long-term patient outcomes and use of healthcare resources were not reported in these trials.Overall, 6.5% (39/602 participants, four trials) developed superficial surgical site infections. There was no significant difference between the groups in the proportion of participants who developed superficial surgical site infections (RR 0.73; 95% CI 0.40 to 1.33). A total of 23 participants (23/625 (3.7%), four trials) developed superficial wound dehiscence. Twenty-two of the 23 participants belonged to the interrupted suture group.The proportion of participants who developed superficial wound dehiscence was statistically significantly lower in the continuous suture group compared to the interrupted suture group (RR 0.08; 95% CI 0.02 to 0.35). Most of these wound dehiscences were reported in two recent trials in which the continuous skin suture groups received absorbable subcuticular sutures while the interrupted skin suture groups received non-absorbable transcutaneous sutures. The non-absorbable sutures were removed seven to nine days after surgery in the interrupted sutures groups whilst sutures in the comparator groups were not removed, being absorbable. The continuous suture technique with absorbable suture does not require suture removal and provides support for the wound for a longer period of time. This may have contributed to the difference between the two groups in the proportion of participants who developed superficial wound dehiscence. There was no significant difference in the length of the hospital stay between the two groups (MD -1.40 days; 95% CI -7.14 to 4.34).

AUTHORS' CONCLUSIONS

Superficial wound dehiscence may be reduced by using continuous subcuticular sutures. However, there is uncertainty about this because of the quality of the evidence. Besides, the nature of the suture material used may have led to this observation, as the continuous suturing technique used suture material that did not need to be removed, whereas the comparator used interrupted (non-absorbable) sutures that did need to be removed. Differences in the methods of skin closure have the potential to affect patient outcomes and use of healthcare resources. Further well-designed trials at low risk of bias are necessary to determine which type of suturing is better.

Relief of pain and anxiety in pediatric patients in emergency medical systems

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Relief of pain and anxiety in pediatric patients in emergency medical systems

Whether a component of a disease process, the result of acute injury, or a product of a diagnostic or therapeutic procedure, pain should be relieved and stress should be decreased for pediatric patients. Control of pain and stress for children who enter into the emergency medical system, from the prehospital arena to the emergency department, is a vital component of emergency care. Any barriers that prevent appropriate and timely administration of analgesia to the child who requires emergency medical treatment should be eliminated. Although more research and innovation are needed, every opportunity should be taken to use available methods of pain control. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can have a positive effect on providing comfort to children in the emergency setting.