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

Overview

Open rhinoplasty leaves a small incision across the columella, and the resulting scar is rarely troublesome when carefully closed. Removing the stitches, however, is painful and takes time. The authors compared a rapidly dissolving suture against a conventional non-dissolving one, on discomfort, scarring and infection.

Sections of note

• 58 consecutive patients had open rhinoplasty with inverted-V midcolumellar incisions by one surgeon. 41 (71 percent) were eligible and studied.
• The first 21 patients were closed with non-resorbable polypropylene 5/0, the next 20 with rapidly resorbable irradiated polyglactic acid 5/0.
• Discomfort from removing the polypropylene sutures was compared with trimming the dissolving sutures at the skin surface one week after surgery.
• Trimming caused significantly less discomfort than removal, p at or below 0.01. Six of 21 patients (29 percent) found suture removal very painful.
• 40 of 41 patients (98 percent) found their scars non-disturbing. Scars were rated invisible or almost invisible by 17 of 21 (81 percent) with polypropylene and 18 of 20 (90 percent) with the dissolving suture.
• Twenty independent surgeons assessing photographs at six months or more rated 16 of 21 (76 percent) and 16 of 20 (80 percent) the same way. No infection occurred. Level of evidence 4.

What it means for a patient

• The dissolving suture removes the painful stitch-removal visit without making the scar worse.
• Nearly a third of patients found conventional suture removal very painful, which is why the comparison was made.
• Almost all patients in both groups were untroubled by their scar, and independent surgeons largely agreed.
• Groups were sequential rather than randomly assigned, one surgeon, 41 patients, and 17 of the original 58 were not assessed.

Why this paper matters

The columellar scar is the standing objection to open rhinoplasty, so any change in how it is closed must be shown not to worsen it. This study shows a comfort gain at no measured cost to appearance or infection. Because assignment was by time period rather than chance, technique may have changed alongside the suture.

Terms

• Transcolumellar incision: the small cut across the strip of skin between the nostrils.
• Resorbable suture: a stitch the body breaks down, requiring no removal.
• Polypropylene: a non-dissolving synthetic suture material.
• Polyglactic acid: a rapidly dissolving synthetic suture material.
• Inverted-V incision: a V-shaped incision design used across the columella.