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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 83-86

Comparative analysis of 6-0 nylon and 6-0 vicryl rapide in congenital unilateral cleft lip repair


Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India

Date of Web Publication2-Aug-2016

Correspondence Address:
Payal Luthra
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon - 122 505, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2125.187512

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  Abstract 

Context: The type of suture material used in surgery has been a long standing debate among surgeons. In this study we compared rapidly absorbable suture material (Vicryl Rapide TM or Irradiated Polygalactin 910) with non-absorbable suture material (Nylon or Polyamide) in patients with nonsyndromic congenital unilateral cleft lip. Aims: To compare the appearance and course of scar, wound infection and patient's parent perception between the two groups. Settings and Design: Randomized prospective controlled study. Methods and Material: 20 patients, in the age group of 3-18 months were randomly allocated to two groups with 10 patients each. Skin suturing was done with 6-0 Polyamide and 6-0 Irradiated polygalactin the respective groups. Patients were evaluated at 1 week, 1 month, 3 months, 6 months and 1 year postoperatively by the observer as well as by the patient's parent. Results and Conclusion: It was found that Vicryl Rapide showed poorer cosmetic outcomes regarding height and pigmentation of scar as compared to nylon sutures.However, this sample size and follow-up period is very small to generalize these findings.

Keywords: Absorbable, chieloplasty, irradiated polygalactin 910, polyamide, sutures


How to cite this article:
Dayashankara Rao J K, Luthra P, Arya V, Siwach V, Sheorain A, Mudgal P. Comparative analysis of 6-0 nylon and 6-0 vicryl rapide in congenital unilateral cleft lip repair. J Cleft Lip Palate Craniofac Anomal 2016;3:83-6

How to cite this URL:
Dayashankara Rao J K, Luthra P, Arya V, Siwach V, Sheorain A, Mudgal P. Comparative analysis of 6-0 nylon and 6-0 vicryl rapide in congenital unilateral cleft lip repair. J Cleft Lip Palate Craniofac Anomal [serial online] 2016 [cited 2022 Jul 6];3:83-6. Available from: https://www.jclpca.org/text.asp?2016/3/2/83/187512


  Introduction Top


Cleft lip patients undergo multiple surgical interventions at a very young age which poses a great challenge for the surgeons to find effective techniques and suture materials for best results. Some prefer nonabsorbable suture material because of its easy handling and a minimal inflammatory response [1] while the others prefer absorbable sutures so as to preclude the need of additional procedures such as sedation or general anesthesia and distressing the child. [2]

Nylon is a synthetic, nonabsorbable, monofilament suture which has low tissue reactivity and high-initial tensile strength which degrades to 50% by 1-2 years. [3] Vicryl rapide is a synthetic suture which shows enhanced absorption in vivo due to effect of gamma radiation. [4]

Since suture removal in these children is a great concern for both the surgeons and parents, [5] we conducted a study to compare the appearance and course of scar and wound infection using an absorbable suture (vicryl rapide) and a nonabsorbable suture (nylon) for skin closure in such patients.


  Materials and methods Top


Twenty patients in the age group of 3 months to 18 months with nonsyndromic congenital unilateral cleft lip (complete or incomplete) were enrolled in the study. The patients were randomly allocated to Group A (closure with 6-0 Polyamide) and Group B (closure with 6-0 vicryl rapide). Informed consent was obtained from parents before surgery. The study was approved by the Institute Ethical Committee. Cleft lip repair was performed by the same surgeon in all patients using Modified Millard's rotational advancement technique and primary rhinoplasty in the complete cleft lip. All patients in Group A required general anesthesia or sedation for removal of sutures on the 7 th postoperative day. Patients in both groups were evaluated in person using a scale which was modified from Vancouver scar scale [Table 1] for observer's assessment and from patient and observer scar assessment scale [Table 2] for assessment of patient's parents' perception. Patients were followed and evaluated at 1 week, 1 month, 3 months, 6 months, and 1 year. Descriptive statistical analysis using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp., was performed. P = 0.05 or less was considered clinically significant.
Table 1: Observer's evaluation proforma

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Table 2: Patient's parent evaluation proforma

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  Results Top


The average age of the patients was 10.3 months in Group A and 6.6 months in Group B. According to the observer, the difference between two groups was significant regarding pigmentation and height of scar at the end of 3 months, 6 months, and 1 year [Figure 1] and [Figure 2] withP> 0.05; the values being higher in irradiated polyglactin 910 group [Table 3]. The pliability and color of scar are displayed in [Table 3] and [Table 4].
Figure 1: Patient photographs for Group A

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Figure 2: Patient photographs for Group B

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Table 3: Comparison of observer's evaluation between Group A and Group B

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Table 4: Comparison between patient's parent evaluation in Group A and B

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  Discussion Top


In our study, vascularity of the scar was statistically insignificant between two groups at all follow-ups. On assessing scar pigmentation by applying mild pressure over the scar, [6] we found greater hypopigmented and hyperpigmented scars in vicryl rapide group with statistically significant difference at 3 months, 6 months, and 1 year. This can be attributed to its absorption mainly through phagocytosis. [7] However, Martelli et al. [8] stated that IRPG is not recommended for facial skin closure.

Pliability [9] was rated in our study on a scale of 1-5 and was assessed subjectively by applying pressure and pinching the skin between fingers. Greater fibrosis and less elasticity were found in vicryl rapide group with statistically significant difference at 3 months (P = 0.029) and 6 months (P = 0.021) and nonsignificant at 1 year as the scar became older which may be attributed to increased tissue activity. [10] Patient's parents' perception which mainly concerns appearance was in contrast to the observer's evaluation regarding stiffness.

Evidence states that the scar height and width depend on the extent of tissue reaction and the amount of wound tension and may lead to the formation of hypertrophic scars and keloids. [11] Scar height was objectively measured as its elevation from the normal skin plane and was higher in vicryl rapide group with a statistically significant difference between the two groups at 3 months (P = 0.032), 6 months (P = 0.008), and 1 year (P = 0.036). Most of the scars were <2 mm in height. Width of the scar was measured using a Vernier caliper, and we found no statistically significant difference between the two groups. Sommerlad and Creasey [12] stated that prolonged tissue support by the monocryl as compared to vicryl rapide causes reduced tension on the scar tissue leading to smaller scars.

The presence of sebaceous glands predispose white roll to postoperative adnexal infections with a higher possibility in multifilaments due to their braided structures. [12] Freshwater et al.[13] found no difference in infection rates between sites sutured with 4-0 novafil and 4-0 vicryl rapide. Tandon et al.[14] noted no cases of stitch abscesses or other wound complications in their study of 236 wounds on vicryl rapide. We encountered only one case of wound infection at 1 week in nylon group. Early disappearance of vicryl rapide sutures seemed to be advantageous in this regard.

Analgesic syrups were routinely prescribed to all patients for 3 days. Pain at the surgical site as rated by the patient's parent was more in vicryl rapide group with a statistically significant difference at 1 week.


  Conclusion Top


There are several limitations to our study. Sample size as well as follow-up period are small. Another important limitation is that the sample includes both complete and incomplete cleft lips which may show different healing characteristics.

Thus, we conclude that the cosmetic appearance of cleft lip scar with vicryl rapide is poorer as compared to the nylon suture of same dimensions at the end of 1 year. Although vicryl rapide has the distinct advantage of being the fastest absorbing synthetic absorbable suture, but providing the patient with a good cosmetic appearance for a lifetime definitely deserves more consideration than avoiding a traumatic surgical procedure for suture removal. However, studies with larger sample size and longer follow-up periods are required to assess the long term influence of these suture materials on scarring and cosmetic appearance and thus generalize these findings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Parell GJ, Becker GD. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds. Arch Facial Plast Surg 2003;5:488-90.  Back to cited text no. 1
    
2.
Collin TW, Blyth K, Hodgkinson PD. Cleft lip repair without suture removal. J Plast Reconstr Aesthet Surg 2009;62:1161-5.  Back to cited text no. 2
    
3.
Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am 2009;89:627-41.  Back to cited text no. 3
    
4.
Matricic D, Kreszinger M, Pirkic B, Vnuk D, Radisic B, Gracner B. Comparative study of skin closure in dogs with polypropylene and polyglactin 910. Vet Arh 2005;75:383-90.  Back to cited text no. 4
    
5.
Bhuiyan M, Chowdhury S, Hoque S, Salek AJ. Evaluation of the outcome of IRPG 910 and polypropylene in terms of cosmesis and cost for skin closure in cleft lip surgery. J Paediatr Surgeons Bangladesh 2010;1:25-9.  Back to cited text no. 5
    
6.
Baryza MJ, Baryza GA. The vancouver scar scale: An administration tool and its interrater reliability. J Burn Care Rehabil 1995;16:535-8.  Back to cited text no. 6
    
7.
Duprez K, Bilweis J, Duprez A, Merle M. Experimental and clinical study of fast absorption cutaneous suture material. Ann Chir Main 1988;7:91-6.  Back to cited text no. 7
    
8.
Martelli H, Catena D, Rahon H, Boukheloua B, Wicart F, Pellerin D. Skin sutures in pediatric surgery. Use of a fast-resorption synthetic thread. Presse Med 1991;20:2194-8.  Back to cited text no. 8
    
9.
McOwan CG, MacDermid JC, Wilton J. Outcome measures for evaluation of scar: A literature review. J Hand Ther 2001;14:77-85.  Back to cited text no. 9
    
10.
Niessen FB, Spauwen PH, Kon M. The role of suture material in hypertrophic scar formation: Monocryl vs. Vicryl-rapide. Ann Plast Surg 1997;39:254-60.  Back to cited text no. 10
    
11.
Shetlar MR, Dobrkovsky M, Linares H, Villarante R, Shetlar CL, Larson DL. The hypertrophic scar. Glycoprotein and collagen components of burn scars. Proc Soc Exp Biol Med 1971;138:298-300.  Back to cited text no. 11
    
12.
Sommerlad BC, Creasey JM. The stretched scar: A clinical and histological study. Br J Plast Surg 1978;31:34-45.  Back to cited text no. 12
    
13.
Freshwater MF. Theopold C, Potter S, Dempsey M, O′Shaughnessy M. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release. J Hand Surg Eur 2012;37:350-3. J Hand Surg Eur 2012;37:705-6.  Back to cited text no. 13
    
14.
Tandon SC, Kelly J, Turtle M, Irwin ST. Irradiated polyglactin 910: A new synthetic absorbable suture. J R Coll Surg Edinb 1995;40:185-7.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
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[Pubmed] | [DOI]



 

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