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COMMENTARY
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 87

Absorbable sutures versus nonabsorbable sutures in cleft lip repair


Department of Cosmetic and Plastic Surgery, Sampige Super Specialty Clinic; Department of Plastic Surgery, KIMS, Hubli, Karnataka, India

Date of Web Publication2-Aug-2016

Correspondence Address:
S S Shirol
Sampige Super Specialty Clinic, 1st Floor, Diwate Complex, Opposite Vasan Eye Care, Club Road, Near Court Circle, Hubli - 580 028, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2125.187514

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How to cite this article:
Shirol S S. Absorbable sutures versus nonabsorbable sutures in cleft lip repair. J Cleft Lip Palate Craniofac Anomal 2016;3:87

How to cite this URL:
Shirol S S. Absorbable sutures versus nonabsorbable sutures in cleft lip repair. J Cleft Lip Palate Craniofac Anomal [serial online] 2016 [cited 2021 Jun 17];3:87. Available from: https://www.jclpca.org/text.asp?2016/3/2/87/187514

Sutures have always created curiosity and debate among plastic surgeons, more so in facial skin closure. Ethilon™ (polyamide/nylon) and prolene (polypropylene) have been traditionally used for skin closure in cleft lip repair. There has been a debate about absorbable sutures versus nonabsorbable sutures in facial skin closure, each having it is own advantages and limitations. With the introduction of vicryl rapide and increasing popularity among pediatric surgeons, we were inspired to use the irradiated vicryl (vicryl rapide/polgalactin) in cleft lip repair. The vicryl rapide seems to offer special advantages over Ethilon™ in ease of handling, ease of knotting and avoids suture removal either under sedation or short general anesthesia in children. However, in spite of being a rapidly absorbable suture, the sutures still remain unabsorbed at 1 month in few patients, necessitating removal. The increased brittleness is another practical problem while tying the knot, or breakage of suture due to crushing by the needle holder, especially for the novice surgeon.

Polyamide or polypropylene has been traditionally used in cleft lip repair. The memory of the suture, difficulty in handling and poor knotting are the problems faced with these sutures. The major drawback of these nonabsorbable sutures in children with a cleft lip is the necessity of suture removal either under sedation or anesthesia. The additional financial burden, risk of second anesthesia, indirect loss of work, and extended hospital stay with the use of nonabsorbable suture needs to be studied.

Another important aspect of any suture is tissue reactivity and the scarring. Abhay nikanth Datarkar et al. [1] compared polypropylene sutures versus vicryl rapide in primary cleft lip repair in sixty patients. There was no significant difference in the rates of infection, wound dehiscence, hypertrophic scar, and cosmetic outcome of the scar.

Our experience of vicryl rapide in primary/secondary, unilateral/bilateral, adult/pediatric cleft lip repair has been quite encouraging. Our unpublished study comparing vicryl rapide versus polyamide did not show any significant cosmetic difference in scarring which is similar to the experience of Datarkar et al. [1] and Bhuyian et al. [2] Another important factor which is of significance, but was not taken into consideration is the reduced hospital stay with the use of vicryl rapide. With the use of vicryl rapide, the patients were treated either on a day care basis or with a one-night hospital stay. Whereas the patients with polyamide sutures were admitted traditionally for 5 days till suture removal.

A long-term study of cost-benefit ratio considering the extended hospital stay with polyamide/polypropylene, additional cost of sedation/anesthesia, increased risk of anesthesia, loss of work and indirect costs in a larger randomized control trial may reveal the benefits of vicryl rapide over nonabsorbable sutures.

 
  References Top

1.
Datarkar AN, Rewanwar D, Rai A. Comperative analysis of unilateral cleft lip closure using absorbable and nonabsorbable sutures: A randomised clinical study. Plast Aesthet Res 2014;1:54-7.  Back to cited text no. 1
    
2.
Bhuyian Md AH, 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 Surg Bangladesh 2010;1:25-9.  Back to cited text no. 2
    




 

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