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Desisto NG, Ortiz AS, Yang SF, Stephan SJ, Patel PN. State of the Evidence for Facial Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:220-229. [PMID: 36603830 DOI: 10.1055/a-2008-2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs micrographic surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs micrographic surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data are discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.
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Affiliation(s)
- Nicole G Desisto
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra S Ortiz
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shiayin F Yang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Luo W, Tao Y, Wang Y, Ouyang Z, Huang J, Long X. Comparing running vs interrupted sutures for skin closure: A systematic review and meta-analysis. Int Wound J 2022; 20:210-220. [PMID: 35715955 PMCID: PMC9797933 DOI: 10.1111/iwj.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/27/2022] [Indexed: 01/07/2023] Open
Abstract
Continuous sutures and interrupted sutures have been widely applied to skin closure after non-obstetric surgery or traumatic wounds. Usually, continuous sutures were divided into transdermal or subcuticular sutures according to whether the stitches were placed through or below the epidermal layer. Interrupted sutures, on the other hand, involved penetration of the loose connective tissue beneath the skin layers, with stitches placed through the external skin layer. Complications including infection, dehiscence, and poor cosmetic appearance were not rare after suturing. Whether a suture method is a suitable option for rapid wound healing and long-term cosmetic appearance remains controversial. To examine the potential benefits and harms of continuous skin sutures vs interrupted skin sutures in non-obstetric surgery or traumatic wounds. Searching websites such as PubMed, the Cochrane Central Library, Web of Science and Embase, and ClinicalTrials.gov were systematically searched up to 5 January 2022 and were assessed and guided by Preferred Reporting Items for Systematic Reviews and Meta-analysis rules as well as guidelines. All relevant randomised controlled studies comparing continuous sutures with interrupted sutures of skin closure were analysed. The suture techniques and material used in each trial were recorded. The transdermal and subcuticular continuous sutures were separately compared with interrupted sutures in the subgroup analysis of dehiscence and cosmetic appearance because the visual appearance of these two continuous suturing techniques was significantly different. Ten studies including 1181 participants were analysed. Subcuticular continuous sutures had comparatively higher visual analogue scale (VAS) scores among patients and doctors than interrupted sutures (OR = 0.27, 95% Confidence Intervals [CI] = 0. 07-0.47, P < .01). Similarly, priority was found regarding transdermal continuous sutures and interrupted sutures (OR = 0.40, 95% CI = 0.21-0.60, P < .01). Five randomised controlled trials (RCTs) demonstrated relevant data about dehiscence events. The incidence of continuous suture was significantly lesser than that of interrupted suture (OR = 0.16, 95% CI = 0.07-0.37, P < .01). There was no significant difference between the infection events rates of two suture methods (OR = 0.69, 95% CI = 0.40-1.21, P = .62, I2 = 0%). This systematic review indicated the superiority of both transdermal and subcutaneous continuous sutures over interrupted sutures in skin closure in terms of wound healing and cosmetic appearance.
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Affiliation(s)
- Wenhao Luo
- Department of General Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yinjie Tao
- Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yawen Wang
- Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhaolian Ouyang
- Institute of Medical Information/Medical LibraryChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Chao K, Elsensohn AN, Singh G, Jiang SIB. Suture materials and techniques for optimal cutaneous wound cosmesis: A systematic review. J Am Acad Dermatol 2021; 86:1136-1137. [PMID: 33892012 DOI: 10.1016/j.jaad.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Kevin Chao
- Department of Dermatology, University of California, San Diego, California.
| | - Ashley N Elsensohn
- Department of Dermatology, University of California, San Diego, California
| | - Gaurav Singh
- Department of Dermatology, University of California, San Diego, California
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Przepiórka Ł, Łabędzka K, Kunert P, Kujawski S, Wójtowicz K, Marchel A. Perioperative Practice Patterns of Craniotomies-Results of a National Neurosurgical Survey in Poland. World Neurosurg 2020; 146:e527-e536. [PMID: 33130140 DOI: 10.1016/j.wneu.2020.10.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioperative craniotomy practices depend mainly on neurosurgeon preferences. To investigate the variations in these preferences, we surveyed neurosurgeons in Poland regarding different aspects of their practices. METHODS Anonymous questionnaires were circulated in 2019 at the neurosurgery conferences in Poland. We then analyzed the responses, categorized in subgroups by sex, affiliation, and stage of training. RESULTS A total of 114 responses to the questionnaire were obtained. For surgical site exposure, regional hair shaving was the most common pattern (64.9%), followed by whole-scalp (19.3%) and strip line shaving (12.3%). Most respondents (65.8%) used clamp-based devices for bone flap fixation, and approximately one third (30.7%) reported using bone suturing. During cranioplasty, respondents most often used artificial bone implants (69.3%), followed by a preserved bone flap from the patient (24.5%). More than three quarters reported that they (77.2%) performed routine radiologic evaluation after uncomplicated brain tumor surgery. Most patients (64.0%) were discharged between the third and sixth postoperative days. Almost half of emergent surgeries (48.2%) and most elective surgeries (89.5%) were performed with the help of an assistant surgeon. No significant differences were found in practice between the sexes or by affiliation or training stage. We inferred an influence of regional economic status on some of the reported choices. CONCLUSIONS Perioperative craniotomy practices among Polish neurosurgeons show a significant heterogeneity. Economic factors can explain some choices, but others trace to a conservative mindset. Further studies are needed to identify which factors are most relevant and to identify approaches to a standardized method of care.
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Affiliation(s)
- Łukasz Przepiórka
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Łabędzka
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Sławomir Kujawski
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Moran B, Humphrey S, Seal A, Berkowitz J, Zloty D. Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: A randomized clinical trial. J Am Acad Dermatol 2020; 83:1395-1399. [PMID: 32534080 DOI: 10.1016/j.jaad.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgeons use absorbable and nonabsorbable sutures for epidermal wound closure. No large, randomized studies have compared the effect of these suture types on facial scar appearance. OBJECTIVE To assess postsurgical facial scar appearance using either rapidly absorbable polyglactin 910 or nylon for epidermal closure. METHODS Randomized, blinded, split-scar clinical trial. A total of 105 patients with facial wounds resulting from Mohs micrographic surgery excisions were randomly assigned for epidermal closure with rapidly absorbable 5-0 polyglactin 910 (Vicryl Rapide) on one half of the repair and 5-0 nylon (Ethilon) on the other half. Two physicians (1 dermatologist and 1 plastic surgeon), unaware of the original suture location, examined photographs of each healed wound at 6 months after surgery and graded the appearance of each half of the scar using the visual analog scale, wound evaluation scale, and Stony Brook Scar Evaluation Scale. RESULTS At 6 months, there was no significant difference in the combined mean (standard deviation) visual analog scale scores (83.1 [14.2] and 83.0 [13.7]), Stony Brook Scar Evaluation Scale scores (4.3 [0.9] and 4.4 [0.9]), or wound evaluation scale scores (5.3 [1.1] and 5.2 [1.1]) for rapidly absorbable polyglactin 910 versus nylon (P = .72, .57, and .21, respectively). LIMITATIONS Single institution. CONCLUSIONS Both rapidly absorbable polyglactin 910 and nylon sutures placed through the epidermis resulted in an equivalent photographic appearance of facial scars at 6 months after surgery.
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Affiliation(s)
- Benvon Moran
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada; Division of Dermatology, Queen's University, Kingston, Ontario, Canada.
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Alexander Seal
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, Canada
| | - Jonathan Berkowitz
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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Quantification of Erythema Associated With Continuous Versus Interrupted Nylon Sutures in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg 2019; 46:757-762. [PMID: 31490310 DOI: 10.1097/dss.0000000000002145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients are often concerned about the cosmetic appearance of scars following Mohs micrographic surgery (MMS), including residual erythema. However, few studies have compared the cosmetic outcomes between different suturing techniques. OBJECTIVE To compare the erythema intensity (EI) associated with interrupted sutures (IS) and continuous sutures (CS), and the degree of its reduction over time. MATERIALS AND METHODS Mohs micrographic surgery patients were randomized to have half of their defect repaired with IS and the other half with CS. Postoperatively, subjects were assessed at 1 week, 2 months, and 6 months and close-up photographs of their scars were taken. Computer-assisted image analysis was utilized to quantify the EI in each half-scar. RESULTS The average EI of IS was greater than that of CS by 9.3% at 1 week (p < .001) and 7.2% at 2 months (p < .021) but comparable at 6 months. These differences were clinically detectable, but EI differences resolved by 6 months in most cases. At 6 months, EI regressed by 33.5% in IS and 26.3% in CS. CONCLUSION Continuous sutures are associated with less erythema during early scar maturation but are comparable to IS at 6 months. These results may guide the choice of suturing technique to improve early cosmetic outcomes and overall patient satisfaction.
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Liu X, Nelemans PJ, Frenk LD, Sengers H, Tuinder SM, Steijlen PM, Mosterd K, Kelleners-Smeets NW. Aesthetic outcome and complications of simple interrupted versus running subcuticular sutures in facial surgery: A randomized controlled trial. J Am Acad Dermatol 2017; 77:911-919. [DOI: 10.1016/j.jaad.2017.04.1128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
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Wang HY, Wang MG, Yu G, Chu YJ, Wang K, Wei XP, Sun JW. Free perforating branch flap for primary repairing the huge soft-tissue defects on the scalp and face. J DERMATOL TREAT 2016; 27:505-509. [PMID: 27044910 DOI: 10.3109/09546634.2016.1161157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to explore the effect of free perforating branch flap on the reconstruction of huge soft-tissue defects on the scalp and face. METHODS Sixteen cases of huge soft-tissue defects on the scalp and face were reconstructed by nine latissimus dorsi-free perforator flaps and seven anterolateral thigh-free perforator flaps. The defects area was from 12 cm× 7 cm to 20 cm × 11 cm, while the flaps area was from 14 cm × 8 cm to 23 cm × 12 cm. The survival, planeness, chromatic aberration, radiotherapy toleration of flap and the function, scar of donor site were observed postoperatively. RESULT All of the flaps were survived completely, and 15 cases presented for primary reconstruction; one underwent secondary reconstruction. One of the patients died one-year postoperatively due to intracranial tumor recurrence and the others had no recurrence. All of the flaps showed perfect shape and appropriate thickness. No roentgen ulcer was observed except for some extent of chromatic aberration. The donor-site scar was larvaceous and the function was good. CONCLUSION This study indicated that the latissimus dorsi-free perforator flap or anterolateral thigh-free perforator flap was an ideal choice for the reconstruction of defects on the scalp and face.
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Affiliation(s)
- Hong-Yuan Wang
- a Department of Plastic Surgery , Anhui Province Hospital , Hefei , P.R. China
| | - Ming-Gang Wang
- a Department of Plastic Surgery , Anhui Province Hospital , Hefei , P.R. China
| | - Gang Yu
- a Department of Plastic Surgery , Anhui Province Hospital , Hefei , P.R. China
| | - Yan-Jun Chu
- a Department of Plastic Surgery , Anhui Province Hospital , Hefei , P.R. China
| | - Kai Wang
- a Department of Plastic Surgery , Anhui Province Hospital , Hefei , P.R. China
| | - Xiang-Pin Wei
- b Department of Neurosurgery , Anhui Province Hospital , Hefei , P.R. China
| | - Jing-Wu Sun
- c Department of Ophthalmology and Otorhinolaryngology , Anhui Province Hospital , Hefei , P.R. China
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