合成吸収糸による頚部皮膚縫合法

Abstract

In neck surgery, the exposed scars of the primary suture should be fine for favorable cosmetic results. We previously used subcuticular and epithelial nylon sutures, but recently we have been using monofilament synthetic absorbable sutures (Polydioxanone; PDS-II®) in subcuticular closure to avoid indurations beneath the skin and late foreign body reactions. The scars of surgical incisions closed with PDS-II® were not inferior to those with nylon sutures, and we report below.In the prevention of hypertrophic scars, providing tensile relief and eliminating level differences of the skin are most important. The tensile strength of PDS-II® is retained for about 2 months, which is not long enough. Thus, subcuticular PDS-II® sutures require sufficient eversion to reduce scar stretching by providing dermal support for longer terms. We call this technique “hypereversion”. This technique does not require the control of degree of eversion according to patient age, and allows uniform sutures.Moreover, to get fine scars without suture marks, we are using film dressing (Op-site®) for wound fixation instead of epithelial suture in the early post operative period. When epithelial suturing is eliminated, level differences of the skin must be avoided in the subcuticular closure.