Suspension Sutures in Facial Reconstruction

BACKGROUND: Suspension, pexing, or tacking sutures were used in facial cosmetic surgery and have recently been used in facial reconstruction. OBJECTIVE: Suspension sutures are used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction (e.g., ectropion or eclabium), to reform a fold that would be obliterated by the motion of tissue, and to prevent tenting across concavities. Although suspension sutures may help to reduce the spreading of scars in wounds closed under tension, they do not prevent some spreading. METHOD: The suturing technique requires a stable structure for attachment of the suspension sutures and lax tissue to advance into the wound. On the face, a stable base exists under junctions of cosmetic units along the orbital rim, zygomatic arch, nasal vestibule, and mental crease of the chin. When the deep roll of the needle includes superficial musculoaponeurotic system with the first segment or the pulling arm of the suspension suture, tissue advancement is obtained. The second or anchoring segment is placed with the needle encompassing a very tight arc traveling in a U-shaped pass into the fascia extending to the periosteum. CONCLUSION: Suspension sutures enable linear closures, prevent distortion of free margins, prevent tenting across concavities, and fix the closure line at the junction of cosmetic units. By redirecting tension, suspension sutures mold surface contours to mimic the natural folds and curves of the face. Judicious use of suspension sutures permits simpler aesthetic reconstructive procedures than might be achieved without their use. Suspension sutures used in this manner help to apply the theoretical concepts of facial reconstruction using facial cosmetic units by performing segmental facial reconstruction.     

Suspension Sutures Aid Facial Reconstruction

Background.  Suspension, pexing or tacking sutures, which have a long history of use in facial cosmetic surgery, have only recently begun use in reconstruction.
Objective.  In this study, the suspension suture was used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction, eg, ectropion or eclabium, to prevent tenting across concavities, and to prevent scar spreading of wounds closed under tension. The acute complications and long-term effectiveness of this suturing technique in achieving the 4 desired results were evaluated.
Methods.  During a 10-year period, 136 cases of surgical defects of the face created by the removal of nonmelanoma skin cancer by Mohs micrographic surgery were repaired using absorbable suspension sutures. The wounds were evaluated initially for acute complications of hemorrhage, infection, dehiscence, and necrosis; and later over 3 years for chronic sequela of hypertrophic scar, spread scar, contraction deformities such as distortion of free margins, and pigmentary changes.
Results.  Suspension sutures were used in 60 cases of primary layered closure and 76 flaps of the face. Suspension sutures allowed primary closure of defects that would have required flaps in 72% of the cases and prevented distortion of free margins. There were more acute and long-term complications related to excess tension with primary closure than with flaps. Suspension sutures fixed the closure line at the junction of cosmetic units, prevented tenting across concavities, and both features were maintained over the duration of the study.
Conclusion.  Suspension sutures aided in obtaining linear closures, prevented distortion of free margins, prevented tenting across concavities, and fixed the closure line at the junction of cosmetic units; however, they did not prevent spread scars.     

The Use of Polypropylene Suture as a Frontalis Suspension Material in All Age Groups of Ptosis Patients

ABSTRACT

Purpose/Aim: To evaluate the use of 2–0 polypropylene suture for frontal suspension in ptosis patients with poor levator function. Materials and Methods: This retrospective study included 20 eyelids of 16 patients (5 female, 11 male) with 4 mm or less levator function. The operation was considered successful when the difference between the two upper lids was ≤1 mm, and the upper lid covered the upper limbus by <3 mm. Results: Median patient age was 22.94 years (2 to 59). Mean follow-up time was 18.06 months (12–29). A successful result was obtained in 14 patients (87.5%). Ptosis recurrence was observed in two patients (12.5%). Lagophthalmos with punctate epithelial keratitis and subsequent spontaneous recovery occurred during the first postoperative week in six patients (37.5%). Two patients with hypocorrection underwent revision surgery in the first postoperative week. Granuloma and material exposition at the forehead incision site observed in one patient at the postoperative fifth month were repaired by excision of the granuloma and suture reposition. Conclusions: Polypropylene suture as a frontalis suspension material in ptosis patients with poor levator function maintained satisfactory results at follow-up. This material allows easy and repeatable eyelid height adjustment and does not obviate future eyelid procedures.     

面部美容式缝合技术在面部创伤患者中的应用效果

目的 研究面部创伤患者在治疗期间应用面部美容式缝合技术的临床效果。方法 选择2021年 1月-2022年10月在我院接受手术治疗的面部创伤患者46例,根据手术所选缝合技术的不同将其分为对照 组和治疗组,每组23例。对照组实施普通清创缝合,治疗组实施面部美容式缝合,比较两组临床指标（手 术时间、水肿持续时间、疼痛消失时间、伤口愈合时间）、治疗效果、不良反应、皮肤切口状态、疼痛 （VAS）及心理状态（SAS、SDS）评分。结果 治疗组手术时间、水肿持续时间、疼痛消失时间、伤口愈 合时间均短于对照组（P ＜0.05）;治疗组治疗总有效率高于对照组（P ＜0.05）;治疗组渗出、硬结发生 率均低于对照组（P ＜0.05）;治疗组皮肤切口各项指标优于对照组（P ＜0.05）;两组治疗后VAS、SAS、 SDS低于治疗前,且治疗组低于对照组（P＜0.05）。结论 面部创伤患者在治疗期间应用面部美容式缝合技 术,能够帮助迅速改善皮肤状态,有效控制瘢痕增生,减轻疼痛,使患者保持良好心理状态,缩短愈合时 间,减少不良反应,使治疗效果得到提升。     

应用双线悬吊法行输精管吻合术的临床研究

目的 报告双线悬吊法行输精管吻合术的临床资料及随访信息,探讨该术式的疗效及优势.方法 选取1996～2010年之间行双线悬吊法输精管吻合术的62名患者为研究对象,分析其术后复查精液常规的结果,并长期随访其生育情况.结果 51例患者获得了随访,其中46例在术后1年之内复查精液分析查见精液,复通率90.2%;完成手术至今,有41例成功使配偶受孕,成功率为80.4%.结论 双线悬吊法行输精管吻合术效果可靠,操作简便,手术时间短,可以推广采用.     

Variations of the Pursestring Suture in Skin Cancer Reconstruction

BACKGROUND: The pursestring suture (PSS) utilizes a circumferentially placed intradermal suture to decrease the size of a defect. Its primary application in dermatologic surgery has been to allow placement of a smaller full-thickness skin graft and to enhance secondary intention wound healing. OBJECTIVE: To present our experience with 3 variations of the PSS. METHODS: The oval defects resulting after surgical excision of cutaneous malignancies were managed with 3 variations of the traditional pursestring technique. These variations included (1) complete closure of the PSS-reduced defect by the placement of traditional interrupted sutures; (2) PSS with the Burow's triangle graft; (3) use of a PSS only part way around an oval defect to avoid distortion of a nearby free margin. RESULTS: In the 7 years of performing these variations of the PSS technique, we have consistently achieved favorable results. CONCLUSION: We report 3 simple-to-use variations of the PSS technique that have been extremely useful in the management of cutaneous malignancies.     

The Versatile V-Y Flap for Facial Reconstruction

BACKGROUND: There are many acceptable treatments for facial skin cancer, but some form of surgical excision is by far the most widely accepted. After surgical excision, there will necessarily be a defect that has to be managed. The V-Y flap is a very useful modality for repair of such defects in all zones of the face. OBJECTIVE: This article reviews the indications for V-Y flaps and the surgical technique that should result in a successful reconstruction. Each zone of the face is independently discussed, along with the appropriate variations in technique for each area. METHODS: An evaluation of the literature as well as the extensive experience of the senior author in performing this procedure provides the basis for this review. CONCLUSION: V-Y flaps are extremely versatile and relatively easy to perform. All areas of the face can be successfully reconstructed after skin cancer removal with V-Y flaps if they are properly designed and executed.     

皮内缝合术在急诊面部创伤治疗中的应用效果

目的 探讨皮内缝合术在急诊面部创伤治疗中的应用效果。方法 选取2021年8月-2023年12月于本 院急诊就诊的80例面部创伤患者为研究对象,以随机数字表法分为常规组与研究组,每组40例。两组均予 以基础术前准备,常规组采用间断缝合术治疗,研究组采用皮内缝合术治疗,比较两组疼痛程度、创面愈 合效果、瘢痕情况以及并发症发生情况。结果 研究组术后1、3 d VAS评分低于常规组,差异有统计学意 义（P＜0.05）;研究组创口愈合总有效率高于常规组,差异有统计学意义（P＜0.05）;研究组瘢痕色泽、 血管分布、厚度、柔软度评分均低于常规组,差异有统计学意义（P＜0.05）;研究组并发症发生率低于常 规组,差异有统计学意义（P ＜0.05）。结论 急诊面部创伤治疗中应用皮内缝合术能够有效提升创面愈合 效果,减轻患者疼痛程度,减少瘢痕形成,并降低并发症的发生几率,值得临床应用。     

美容缝合修复在急诊面部创伤中的应用效果

目的 分析美容缝合修复在急诊面部创伤中的应用效果。方法 选取2021年1月-2022年1月我院 收治的58例急诊面部创伤患者为研究对象,随机分为观察组和对照组,各29例。对照组应用传统急诊 清创缝合技术,观察组应用美容缝合修复,比较两组创面愈合情况、恢复优良率、手术时间、创面愈 合时间、焦虑评分（HAMA）以及满意度评分。结果 观察组创面愈合评分低于对照组（P＜0.05）;观 察组恢复优良率高于对照组（P＜0.05）;两组手术时间比较,差异无统计学意义（P＞0.05）;观察组创 面愈合时间短于对照组（P＜0.05）;观察组焦虑评分低于对照组（P＜0.05）;观察组满意度高于对照组 （P＜0.05）。结论 美容缝合修复应用于面部急诊患者中可以提升创伤修复效果,缩短创面愈合时间,减 轻患者的焦虑情绪,提升患者满意度,值得临床应用。     

应用双线悬吊法行兔输精管吻合术的实验研究

目的 应用双线悬吊法行兔输精管吻合术,并探讨其安全性和有效性.方法 将30只雄性新西兰白兔随机分为3组,Ⅰ组在剪断输精管后即刻行双线悬吊法输精管吻合术,即以10 -0无创伤缝合线行输精管全层缝合两针,牵引缝线使两侧输精管断端无张力、无扭曲对合,牵引线缝出皮肤,打结固定于切口,10天后抽出牵引线.Ⅱ组和Ⅲ组分别在输精管...     

美容缝合技术在面部外伤患者中的应用效果

目的 探讨美容缝合技术在面部外伤患者中的应用效果。方法 选取2021年1月-2022年6月我科 收治的80例面部外伤患者为研究对象,采用随机数字表法分为常规组和美容组,各40例。常规组行常规缝 合,美容组行美容缝合,比较两组缝合时间、缝合费用、术后伤口愈合情况、瘢痕主客观评价结果。结果 美容组缝合时间、缝合费用均高于常规组（P＜0.05）;美容组甲级愈合率为97.50%,高于常规组的87.50% （P＜0.05）;美容组满意度评分高于常规组,瘢痕面积、瘢痕长度小于常规组（P＜0.05）。结论 美容缝 合技术在面部外伤患者中的应用效果确切,相比于常规缝合方式,美容缝合技术虽然缝合时间稍长、费用 稍高,但伤口愈合情况更为理想,且术后瘢痕不明显,患者满意度较高,值得临床应用。     

早期美容缝合在面部外伤患者中的应用效果

目的 探讨美容缝合对面部外伤创面愈合质量的影响。方法 选取2021年1月-2022年1月我院收 治的100例面部外伤患者为研究对象,采取随机数字表法分为观察组与对照组,各50例,对照组采用常 规清创缝合,观察组采用早期美容缝合。比较两组创面愈合效果、不良反应发生情况、术后1个月及1年 瘢痕形成情况。结果 两组治疗后温哥华瘢痕量表评分均低于治疗前,且观察组低于对照组,差导有统计 学意义（P＜0.05）;观察组创面愈合用时短于对照组,差异有统计学意义（P＜0.05）;两组治疗后10、20 d 疼痛评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）;观察组术后1个月及术后 1年瘢痕指数均低于对照组,差异有统计学意义（P＜0.05）;观察组不良反应发生率低于对照组,差异有 统计学意义（P＜0.05）。结论 早期美容缝合应用于面部外伤治疗中,可有效改善创面愈合质量,加快愈 合,降低术后不良反应发生率以及患者疼痛感,减少瘢痕形成,值得临床应用。     

精细缝合与局部皮瓣在面部外伤修复中的应用

目的 探究精细缝合与局部皮瓣在面部外伤修复中的应用效果。方法 选取2021年1月-2023年1月 丹阳市人民医院烧伤整形外科收治的面部外伤患者50例,随机分为对照组和观察组,各25例。对照组行传 统缝合方式修复,观察组则采用精细缝合与局部皮瓣方式修复,比较两组临床症状情况,治疗前、后瘢 痕美观度评分、瘢痕程度评分、并发症发生率以及炎性因子水平。结果 观察组并发症发生率低于对照组 （P＜0.05）;两组治疗后IL-1、IL-6以及TNF-α水平均低于治疗前,且观察组低于对照组（P＜0.05）; 两组治疗后VSS各项评分均低于治疗前,且观察组低于对照组（P＜0.05）;两组治疗后PSAS、OSAS以 及POSAS评分均低于治疗前,且观察组低于对照组（P＜0.05）;观察组瘢痕长度、水肿持续及切口愈合 时间均短于对照组（P＜0.05）;观察组治疗总有效率高于对照组（P＜0.05）。结论 在面部外伤修复中 应用精细缝合与局部皮瓣,可提高美容效果和创口修复质量,降低瘢痕增生及炎症反应,有效且安全。 【关键词】面部外伤;精细缝合;局部皮瓣;瘢痕