Barbed sutures “lunch time” lifting: evidence‐based efficacy

There is a growing trend nowadays for patients to seek the least invasive treatments possible with less risk of complications and downtime to correct rhytides and ptosis characteristic of aging. Nonsurgical face and neck rejuvenation has been attempted with various types of interventions. Suture suspension of the face, although not a new idea, has gained prominence with the advent of the so called “lunch‐time” face‐lift. Although some have embraced this technique, many more express doubts about its safety and efficacy limiting its widespread adoption. The present review aims to evaluate several clinical parameters pertaining to thread suspensions such as longevity of results of various types of polypropylene barbed sutures, their clinical efficacy and safety, and the risk of serious adverse events associated with such sutures. Early results of barbed suture suspension remain inconclusive. Adverse events do occur though mostly minor, self‐limited, and of short duration. Less clear are the data on the extent of the peak correction and the longevity of effect, and the long‐term effects of the sutures themselves. The popularity of barbed suture lifting has waned for the time being. Certainly, it should not be presented as an alternative to a face‐lift.     

Aesthetic and functional efficacy of subcuticular running epidermal closures of the trunk and extremity: a rater-blinded randomized control trial

OBJECTIVE: To ascertain whether subcuticular epidermal closures of elliptical excisions of the trunk and extremities result in better functional and cosmetic outcomes than simple running epidermal closures of the same sites. DESIGN: Randomized controlled trial, with allocation of epidermal closure of elliptical excisions to 4 arms, including 1 control arm (simple running polypropylene sutures removed after 14 days) and 3 experimental arms (subcuticular running polypropylene sutures removed after 14 days, subcuticular running polypropylene sutures left in place, and subcuticular running polyglactin 910 sutures left in place). All experimental interventions were preceded by deep dermal closure with simple interrupted polyglactin 910 sutures. Interventions were delivered by 3 surgeons, who underwent 2 training sessions to minimize intersurgeon technique variability. SETTING: Institutional referral practice providing ambulatory care in an urban environment. PATIENTS: A consecutive sample of 36 adult patients (ages 18-65 years), each referred for concurrent elliptical excision of at least 2 clinically atypical nevi of the trunk and/or extremity, were included in the study. MAIN OUTCOME MEASURES: Primary outcome measures obtained at 3 and 9 months included scar width in millimeters and blinded observer ordinal scale assessment of overall scar appearance. Secondary outcome measures included ratings on the standardized Vancouver Scar Scale and the Hollander Scar Scale; an additional nonstandard item was added to assess pruritus. RESULTS: No difference among groups was found in scar width at 3 or 9 months. Differences among groups were detected in overall scar appearance (3 months, P<.001; 9 months, P<.001), vascularity (3 months, P = .001; 9 months, P<.001), excessive distortion (3 months, P = .04; 9 months, P = .02), contour irregularity (3 months, P<.001), and edge inversion (3 months, P = .01). The best overall appearance was with a subcuticular running polyglactin 910 suture left in place, and the next best was with a subcuticular running polypropylene suture left in place; differences across groups persisted but decreased in intensity at 9 months. A secondary analysis that matched high-tension anatomic sites (back and lower leg), and high and moderate tension sites (also chest and shoulder) yielded the same main effects and mostly the same results in pairwise comparisons. CONCLUSION: While scar width does not appear to vary significantly based on choice of epidermal closure, bilayered closures of the trunk and extremity have better overall appearance and less associated erythema at 3 and 9 months after surgery with the use of a subcuticular running polyglactin 910 suture left in place.     

Utility of fully buried horizontal mattress sutures

BACKGROUND: Deep absorbable stitches should provide a firm closure, hemostasis, and good wound-edge eversion, but this is not always achieved with standard techniques. OBJECTIVE: We sought to investigate alternative techniques that can rapidly and reliably achieve these results. METHODS: We evaluated the fully buried horizontal mattress suture. We compared this technique with the previously described fully buried vertical mattress, partially buried mattresses, and standard reticular dermal and subcutaneous sutures. RESULTS: The fully buried horizontal mattress can provide excellent wound-edge approximation and eversion. It is particularly useful for shallow defects and narrow spaces where a deep stitch is required but technically difficult to insert. Overall, this method offers excellent final cosmesis, and individual sutures can be quickly and reproducibly placed with minimal practice. For very deep defects that require dead-space closure, the fully buried vertical mattress may be preferable. CONCLUSIONS: The buried horizontal mattress suture has wide applicability as the buried stitch in a bilayer repair.     

Experimental Investigation on the Tissue Response Induced by Face-Lifting Mesh Suspension Thread in Rats

BackgroundFace-lifting procedures are often performed to hide the effects of aging. Thread-lifting, a minimally invasive technique for the correction of facial aging, has become increasingly popular, and various materials for the procedure have been developed.ObjectiveThis study compared tissue responses to two types of threading sutures placed under rat skin: polypropylene (PP) monofilament mesh suspension thread (a novel face-lifting material) and polydioxanone (PDO) barbed thread.MethodsEight rats each were assigned to the PP monofilament mesh suspension, PDO barbed thread, and control groups. Tissue reactions were evaluated 28 days after subcutaneous loading of the materials.ResultsSignificant increases in tensile strength and the mean area occupied by collagen fibers were evident in skin loaded with PDO barbed thread and PP monofilament mesh suspension thread compared to control skin (p<0.05). Compared to sites loaded with PDO barbed thread, those loaded with PP monofilament mesh suspension thread showed a significant increase in the number of collagen fibers and a lower grade of inflammation (p<0.05).ConclusionPP monofilament mesh suspension thread has skin-rejuvenating effects comparable to those of PDO barbed thread, but induces a less severe inflammatory response. This indicates that it is a safe and effective material for use in thread-lifting procedures on aging skin.     

Barbed polyglyconate vs monocryl suture in vesico-urethral anastomosis during robot-assisted radical prostatectomy

AIM: To compare outcomes using barbed polyglyconate(V-Loc 180) vs monofilament monocryl suture in forming vesico-urethral anastomosis(VUA) during robot assisted radical prostatectomy.METHODS: Review of prospectively collected robot assisted radical prostatectomy data between July 2011 and September 2012. VUA technique: VUA was performed using 2 cm × 15 cm 2/0 V-Loc 180 continuous sutures or 3/0 monofilament monocryl sutures. Anastomotic integrity was tested intra-operatively with a water leak test. All patients had a post-operative cystogram at day 7 to 10.RESULTS: There were 189 patients in the study with 113 in the V-Loc group and 76 in the monocryl group. Demographics were similar for both groups P 0.05). The median operative time for V-Loc group was 130 min and monocryl group was 145 min, which was statistically significant(P 0.001). The median blood loss for both groups was 200 m L with no significant difference(P = 0.260). The pathology results of the 2 groups were similar(P = 0.537). Four patients in the V-Loc group and two patients in the monocryl group had radiological urinary leak. This was not statistically significant(P = 1.00) and all patients improved with conservative management. The continence rates were comparable for both groups.CONCLUSION: V-Loc suture significantly reduced operative time facilitating ease of VUA formation. Overall functional outcome and urinary morbidity were not significantly different from the monofilament group.     

Reduction of face and neck laxity with anchored, barbed polypropylene sutures (Contour Threads)

The use of nonabsorbable sutures for lifting lax, aging skin is an increasingly popular option for cosmetic surgeons. Contour Thread (Surgical Specialties Corp.) are novel modified polypropylene sutures recently approved for this purpose by the US FDA. Design and technical modifications incorporated into this implant may reduce complications and limitations seen with previous, similar products. Early experience has been positive, although the durability of cosmetic effect and the potential for long-term complications remain to be seen.     

Effect of different suture techniques on tension dispersion in cutaneous wounds: A pilot study

Background/Objectives: Wound tension plays an integral role in both wound healing and cosmesis. The use of W‐plasty has been shown to evenly distribute tension, but is difficult to use in cutaneous surgery. This pilot study aimed to review suture techniques that may give the same wound‐tension distribution as W‐plasty. Methods: Porcine skin mounted on a standard board was used. A standard grid was superimposed onto the tissue, and an incision was made which was digitally photographed. The defect was then sutured using three suture techniques: simple interrupted sutures, mattress sutures and mattress sutures with knots on alternate sides. Subcutaneous sutures were also used in conjunction with each of these suturing techniques. The grid points were compared and the variation from baseline recorded. These variations were then graphed. Results: The simple interrupted and mattress sutures showed bias of tension opposite to the side of the knot. The alternate mattress suture demonstrated a more even distribution of tension. Conclusion: The mattress suture with alternating knots had a tension pattern that distributed the forces equally across the wound. This is similar to the pattern of W‐plasty, suggesting the technique may be used for improved wound healing and cosmesis in areas of tension.     

不同阴道残端缝合法对非脱垂子宫全切术后性功能影响的临床研究

目的：针对不同阴道残端缝合方法应用于子宫全部切除手术对性功能的影响进行探讨。方法：选择2010年6月至2012年6月,在我院妇科进行筋膜内子宫全切除手术的360例患者,按照随机数字表方法将患者分成三组,每组患者120例,Ⅰ组患者医师针对阴道残端进行左右扣锁缝合;Ⅱ组患者医师针对阴道残端进行对侧缝合;Ⅲ组患者医师针对阴道残端进行连续缝合。在各组患者手术之后的第5、10、18个月跟踪随访,对患者术后的性生活质量、压力性尿失禁、盆底肌力、阴道顶部脱垂进行评估。结果：Ⅰ、Ⅱ、Ⅲ组患者在手术之后的第5、10、18个月对患者术后的性生活质量、压力性尿失禁、盆底肌力、阴道顶部脱垂情况比较,具有统计差异（P〈0.05）,发生率依次是Ⅰ〉Ⅱ〉Ⅲ组,但是Ⅱ、Ⅲ组直接没有统计差异（P〉0.05）。结论：患者进行子宫全切手术,Ⅱ、Ⅲ组的缝合方式优于Ⅰ组,可以有效的保护患者的盆底功能,减少了患者由于压力造成尿失禁的情况或者是阴道顶部脱垂发生的可能性,对性功能影响较小,值得临床推广。     

Use of absorbable suture material in dermatologic surgery

Absorbable synthetic suture material (Vicryl, PDS) alone was used for wound closure in 1860 surgical interventions on the skin. The PDS suture is totally inert in intracutaneous tissue, and proved superior to the Vicryl suture. In combination, PDS sutures can also be used intracutaneously as well as conventionally. Additional advantages of absorbable material are the possibility of meandering and everted stitches in continuous intracutaneous sutures, no need for removal in most cases, and avoidance of intracutaneous scar dehiscences because of the good durability of the suture material.     

Trends of chromosomally mediated antimicrobial resistance in Neisseria gonorrhoeae in Canada: 1994-1999

BACKGROUND AND OBJECTIVES: We monitored the trends of chromosomally mediated resistant Neisseria gonorrhoeae (CMRNG) in Canada. Chromosomally resistant N. gonorrhoeae (CMRNG) were defined as having resistance to 3 antibiotics: penicillin (minimum inhibitory concentration [MIC] > or =2.0 mg/L), tetracycline (MIC > or =2.0 mg/L and < or =8.0 mg/L), and erythromycin (MIC > or =2.0 mg/L). GOAL: The goal was to provide surveillance data for public health interventions for the control of gonococcal infections. STUDY DESIGN: Antibiotic susceptibility tests were performed on N. gonorrhoeae isolates obtained from 1994 to 1999 in Canada. Strains were further characterized by auxotype (A), serovar (S), and plasmid profile (P). RESULTS: Between 1994 and 1999, 19.2% of strains were CMRNG, 12.9% had a combined resistance to tetracycline and erythromycin, and 4.7% were resistant to tetracycline. The incidence of ciprofloxacin resistance and azithromycin resistance was 2.3% and 0.8%, respectively. CONCLUSION: This survey of N. gonorrhoeae provides strain characterization data and temporal trends of strains in the Canadian population. CMRNG strains are on the rise, and the continual monitoring and characterization of these strains is important for the evaluation of current recommended antibiotic therapies used in Canada.     

Irradiated polyglactin 910 for mucosal defects

The prolonged presence of superficial mucosal sutures or perineal sutures may cause irritation or discomfort and increase the risk of bacterial infections. Although absorbable sutures are commonly used in mucosal areas, many sutures have a prolonged half-life and might still require removal when used superficially. We highlight the use of irradiated polyglactin 910 (IRPG) for closure of mucosal defects and areas where short-term wound support is required. We used IRPG in 50 patients for closure of defects on the lips, oral mucosa, and penis. In all cases, IRPG sutures provided appropriate tensile strength with minimal inflammation, suppuration, or irritation. IRPG resulted in low inflammatory response, rapid degeneration, soft feel, and easy workabil-ity, making it an ideal suture option for closure of mucosal defects and areas where short-term wound support is desired.     

A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents

BACKGROUND: Recent studies suggest that the use of octyl cyanoacrylate tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds results in a cosmetic outcome comparable to that achieved with conventional sutures. To date, no studies have looked at the use of tissue adhesive for higher-tension wounds, such as those created during cutaneous excisional procedures. OBJECTIVE: To compare the tissue adhesive octyl cyanoacrylate with standard suture for the closure of excisional wounds in children and adolescents. DESIGN: A prospective comparison with blinded assessment of cosmetic outcome. Twenty-eight wounds were closed with monofilament suture and 24 were closed with tissue adhesive. At approximately 2 months, photographs of the incisions were evaluated by 2 dermatologists blinded to the method of skin closure. SUBJECTS: Forty-two consecutive patients undergoing excisional dermatologic procedures at Children's Hospital, San Diego, Calif. These 42 patients had a total of 52 wounds that were evaluated. MAIN OUTCOME MEASURES: The cosmetic appearance of the wounds at 2 months, based on 2 validated wound scales: the Hollander Wound Evaluation Scale and a visual analog scale. RESULTS: There were no differences in early complications between the groups. The suture group scored higher on the visual analog scale (63.3 mm for suture vs 47.8 mm for tissue adhesive), and this difference was statistically significant (P =.02). The suture group also had a higher median score on the Hollander Wound Evaluation Scale, but this difference was not statistically significant (P =.09). CONCLUSION: The cosmetic outcome of cutaneous excisional surgery wounds closed with standard suturing was found to be superior to that of wounds closed with octyl cyanoacrylate.     

Suture material in cosmetic cutaneous surgery.

Optimal cosmetic surgical results are dependent, in part, on the chosen suture material. Given the importance of sutures in wound healing, it is imperative for the esthetic physician to choose the correct suture material. There are a wide variety of suture materials available and each material presents advantages and disadvantages. An ideal suture material has great strength and knot security while remaining elastic with minimal tissue reactivity. Given that there is no single suture material that is ideal for all situations, the cosmetic physician must decide which material is best suited for the particular closure. This review will address the major properties of common suture materials and describe their advantages and disadvantages.     

Simplified atraumatic wound closure of skin defects

A simplified technique of atraumatic tape-suture wound closure was performed by means of horizontal and vertical fixation of Squibb Dermahesive strips along and upon the wound margins; this method was combined with various suture techniques (i.e. interrupted sutures, vertical mattress sutures, half buried/mattress sutures, subcuticular and subcutaneous sutures).     

Intradermal buried vertical mattress suture as sole skin closure: evaluation of 149 cases

Various buried suture techniques have been reported for dermatological surgery, but in most cases, superficial non-absorbable sutures are placed additionally. The aim of this study was to evaluate whether the intradermal buried vertical mattress suture can be safely used without additional skin suturing. Following 149 procedures in 126 patients, the colour and dehiscence of the scar and the presence of hypertrophy, granulomas or keloids were analysed. The cosmetic results were excellent to good in 78.5%, satisfactory in 19.5% and poor in 2%. Single additional superficial sutures had to be placed in only 14.7%. Suture marks were absent. Hypertrophic scarring was significantly more frequent in scars sutured with polyglactine than in scars sutured with polydioxanone. Early wound dehiscence, secondary wound healing and infection due to missing superficial skin sutures did not occur. This suture technique is safe, easy and fast to perform, and achieves good cosmetic results without leaving suture marks.     

Androgen metabolism by isolated human axillary apocrine glands in hidradenitis suppurativa

Androgen metabolism was investigated in normal human apocrine glands and in those isolated from age-matched patients with hidradenitis suppurativa. Axillary glands were isolated by shearing and androgen interconverting enzyme activities were measured in cell-free homogenates by incubation with [3H] dehydroepiandrosterone, [3H] androstenedione and [3H] testosterone. The activities (pmol/mg protein/min: mean + SEM) of 3 beta-hydroxysteroid dehydrogenase delta 4-5-isomerase (10.0 +/- 1.2 vs. 5.3 +/- 0.5: n = 5) and 17 beta-hydroxysteroid dehydrogenase (58.1 +/- 4.5 vs. 35.7 +/- 5.2: n = 5) were significantly lower (P less than 0.005) in hidradenitis suppurativa, whereas 5 alpha-reductase activity (12.5 +/- 2.3 vs. 12.5 +/- 2.0: n = 5) was similar. This report suggests that hidradenitis suppurativa cannot be attributed to exaggerated activities of end-organ androgen interconverting enzymes.     

Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya

OBJECTIVE: The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya. STUDY DESIGN: Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction. RESULTS: At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5-4.0), GC (HR = 2.0; 95% CI = 1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and >or=7 months, respectively. CONCLUSION: The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women.     

Atraumatic closure of skin defects

A method of atraumatic wound closure published by Ambroise Pare [1] was carried out by suturing of crosstrips (Mefix-M?lnlycke) fixed along and upon the wound margins, combined with intradermal continuous sutures (absorbable monofilament polydioxanone--4-0, Ethicon).     

Quantification of wound oedema after dermatological surgery

Background Postoperative wound oedema causing increased suture tension is thought to be a possible cause of scars known as suture marks. Quantification of such oedema has not previously been reported in the literature. Measures to accommodate wound oedema may include the adoption of alternative suture techniques and the use of more elastic suture materials. Objectives To quantify wound expansion after skin surgery and to identify any contributory factors, and to determine the ability of eight commonly used skin suture materials to stretch under increasing tension. Methods Forty consecutive adult patients attending a dermatology department for routine skin surgery in December 2002 were recruited. Details including body site, nature of the lesion excised and dimensions of the open wound were recorded. The distance between entry and exit points of an untied suture at the time of skin surgery was measured and then repeated 24 h postoperatively. The ability of eight different suture materials to stretch when an increasing force was applied was measured by hanging standard weights from the sutures and measuring the suture length for each force applied. Results Thirty‐nine patients completed the study. All wounds expanded postoperatively, with a mean lateral expansion of 1·0 mm. There was a strong association between the width of the unsutured wound after excision and the subsequent wound expansion. Commonly used sutures in skin surgery were found to be relatively inelastic at forces under 0·2 kg. The monofilament Novofil™ (Davis & Geck, Danbury, CT, U.S.A.) exhibited the greatest degree of stretch of those tested. Conclusions There is considerable oedema in the first 24 h after skin surgery, particularly with wider excisions. This needs to be considered when choosing suturing materials and techniques to avoid excessive suture tension.     

山柰素等7种中药单体对酪氨酸酶的激活作用

目的:研究对酪氨酸酶有激活作用中药中的一些主要单体对酪氨酸酶激活率的影响,从而为色素减退或色素脱失性皮肤病的治疗提供天然化学药物。方法:选取7种中药单体,采用蘑菇酪氨酸酶多巴速率氧化法体外测定酪氨酸酶活性。结果:柚皮素、愈创木酚、滨蒿内酯、7-甲氧基香豆素对酪氨酸酶具有轻度的激活作用(P<0.05),酪氨酸酶激活率均低于20%。0.5、1.0、2.0和4.0mmol/L山柰素对酪氨酸酶激活率呈剂量依赖性升高,2.0mmol/L山柰素对酪氨酸酶的激活率达110%。山柰素与8-甲氧沙林(8-MOP)浓度相同时其酪氨酸酶激活率明显高于8-MO(PP<0.01)。结论:山柰素对酪氨酸酶有明显的激活作用。