Proper suturing technique is essential for obtaining good cosmetic results and for preventing scarring and poor healing of the wound. Characteristics of an ideal wound closure technique include: providing maximal wound eversion; maintaining tensile strength throughout the healing process; being technically simple and fast for the surgeon to perform; and allowing for precise wound edge approximation without leaving suture marks. There are a large variety of suturing methods available to the plastic surgeon and more than one of these techniques may be appropriate for any single wound closure. The simple interrupted suture is the simplest and most frequently employed type of suture. The vertical mattress suture is used principally to ensure eversion of skin edges, but is rarely indicated on the face. A common technique for wound closure is to alternate a vertical mattress suture with a simple interrupted suture along the length of the wound. This report outlines a new method for closing skin wounds which combines the horizontal and vertical mattress sutures. This horizonto- vertical mattress suture is easy and quick to perform, achieves precise wound approximation, provides good eversion of skin edges maintaining uniform tensile strength, reduces the risk of suture marks and gives good cosmetic results, and it can be widely applicable to the whole body area wound, including the face.
Cicatrix ; Skin ; Sutures* ; Tensile Strength ; Wound Closure Techniques ; Wounds and Injuries

The ideal method of wound closure should be simple, rapid, inexpensive, painless, and bactericidal, and should achieve optimal cosmetic results. Tissue adhesives offer many of these characteristics. Until recently, the only commercially available tissue adhesive was 2-butylcyanoacrylate. A new tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), offers several advantages over 2-butylcyanoacrylate. It is more pliable and less brittle. To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of open wound, two groups of each 20 rats were studied. Two groups were similar for demographic and clinical characteristics. Photographs taken at three months were rated by seven plastic surgeons blinded to the method of closure. There was no difference between two groups for appearance or complication. In conclusion, wound treated with Dermabond(R) and standard wound closure techniques have similar cosmetic results 3 months later, and Dermabond(R) is a faster method of wound repair that has cosmetic results similar to the use of sutures.
Animals ; Rats* ; Sutures ; Tissue Adhesives ; Wound Closure Techniques* ; Wounds and Injuries*

OBJECTIVE: The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. METHODS: Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. RESULTS: A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance (P=0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r, −0.63; P < 0.01). CONCLUSION: We suggested the use of intradermal buried vertical mattress as a cosmetically superior skin closure method for application in cesarean sections over subcuticular stitch.
Abdominal Wound Closure Techniques ; Cesarean Section ; Cicatrix ; Cosmetic Techniques ; Female ; Humans ; Methods ; Pregnancy ; Retrospective Studies ; Skin ; Sutures ; Telephone ; Wound Healing

BACKGROUND: The elliptical excision is the standard method of removing benign skin lesions, such as congenital melanocytic nevi. This technique allows for primary closure, with little to no dog-ear deformity, but may sacrifice normal tissue adjacent to the lesion, resulting in scars which are unnecessarily long. This study was designed to compare the predicted results of elliptical excision with those resulting from our excision technique. METHODS: Eighty-two patients with congenital melanocytic nevus on the face were prospectively studied. Each lesion was examined and an optimal ellipse was designed and marked on the skin. After an incision on one side of the nevus margin, subcutaneous undermining was performed in the appropriate direction. The skin flap was pulled up and approximated along several vectors to minimize the occurrence of dog-ear deformity. RESULTS: Overall, the final wound length was 21.1% shorter than that achieved by elliptical excision. Only 8.5% of the patients required dog-ear repair. There was no significant distortion of critical facial structures. All of the scars were deemed aesthetically acceptable based on their Patient and Observer Scar Assessment Scale scores. CONCLUSIONS: When compared to elliptical excision, our technique appears to minimize dogear deformity and decrease the final wound length. This technique should be considered an alternative method for excision of facial nevi.
Cicatrix ; Congenital Abnormalities ; Humans ; Nevus ; Nevus, Pigmented ; Prospective Studies ; Skin ; Wound Closure Techniques

This study is to compare a tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), with conventional wound closure techniques for vertical reduction mammaplasty. Twenty patients presenting large breast from November to December 2005 were enrolled into this prospective clinical trial study. These patients' breasts were randomly assigned to treatment with either 2-octylcyanoacrylate or 5-0 monofilament sutures. Photography taken at six months after treatment were rated by two plastic surgeons and six layperson blinded to the method of closure. There was no significant difference between the two groups for appearance scores based on a visual analog scale(81.9mm for 2-octylcyanoacrylate versus 75.7mm for 5-0 monofilament sutures). The length of time for periareoalr repair was decreased in the 2-octylcyanoacrylate group(2.7 minutes for 2-octylcyanoacrylate versus 8.3 minutes for 5-0 monofilament sutures, p<0.001). The patients' satisfaction rate in the 2-octylcyanoacrylate group was high. Moreover, the use of 2-octylcyanoacrylate obviates the need for suture removal. In conclusion, the use of 2-octylcyanoacrylate for vertical reduction mammaplasty is an acceptable alternative which includes several advantages to conventional suturing with a comparable cosmetic outcome.
Breast* ; Female ; Humans ; Mammaplasty ; Photography ; Prospective Studies ; Sutures ; Tissue Adhesives ; Wound Closure Techniques

Congenital melanocytic nevus consists of congregations of nevomelanocytes. It is found in approximately 1% of new born infants. Congenital melanocytic nevus needs to be excised before it transforms into a malignant lesion. Many strategies have been attempted for the removal and reconstruction of the nevus. Serial excision enables wound closure to be accomplished with a shorter scar than if the original lesion was elliptically excised in a single stage and reorientation of the scar closer to the relaxed skin lines. The routine utilization of an elliptical serial excision as a standard method of closure often leads to the formation of elongated scars and waste of skin. The "Cogwheel pattern" serial excision is a new technique for reducing the size of the nevus efficiently. Reducing the final scar length, distributing the tension over many directions, and having the chance of decrease in operation numbers are ultimately achieved with the use of the "Cogwheel pattern" serial excision.
Cicatrix ; Humans ; Infant ; Nevus ; Nevus, Pigmented* ; Skin ; Surgical Flaps ; Wound Closure Techniques ; Wounds and Injuries

PURPOSE: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. MATERIALS AND METHODS: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. RESULTS: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. CONCLUSION: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.
Angiography* ; Arteries* ; Fascia ; Perforator Flap* ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer* ; Wound Closure Techniques

PURPOSE: Surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. Reports have described differences in the incidence of wound infection depending on the skin closure technique, but there is no consensus on the ideal closure technique for a stoma wound. The aim of this study was to compare the incidence of SSI and the patient satisfaction between a circumferential purse-string approximation (CPA) and a primary linear closure (PC) of a stoma wound. METHODS: This prospective nonrandomized trial enrolled 48 patients who underwent a stoma closure from February 2010 to October 2013. Patients were divided into two groups according to the stoma closing technique: the CPA group (n = 34) and the PC group (n = 14). The incidences of SSI for the two groups were compared, and the patients' satisfaction with the stoma closure was determined by using a questionnaire. RESULTS: SSI occurred in 3 of 48 patients (6.3%) and was more frequent in the PC group than in the CPA group (3/14 [21.4%] vs. 0/34 [0%], P = 0.021). Time to complete healing after stoma closure in the CPA group was 32 days (range, 14-61 days). Patients in the CPA group were more satisfied with the resulting wound scar (P = 0.043). CONCLUSION: After stoma closure, CPA was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to PC. However, with the CPA technique, the time to heal is longer than it is with PC.
Cicatrix ; Consensus ; Humans ; Incidence* ; Patient Satisfaction* ; Prospective Studies ; Skin* ; Surgical Stomas ; Wound Closure Techniques ; Wound Infection* ; Wounds and Injuries ; Surveys and Questionnaires

PURPOSE: S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. METHODS: S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. RESULTS: All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). CONCLUSION: We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.
Centers for Disease Control and Prevention (U.S.) ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Perioperative Period ; Pilonidal Sinus ; Recurrence ; Surgical Flaps ; Surgical Wound Infection ; Wound Closure Techniques ; Wound Healing

PURPOSE: This study investigates the current situation and future trends in the field of cataract and refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been surveyed annually on cataract and refractive surgery. The 2005 annual survey, consisting of 74 multiple-choice questions, was mailed in February 2005 to 364 KSCRS members. Seventy-six (20.8%) members answered. Current data were compared with those of previous annual surveys and with those of annual surveys of ASCRS (American Society of Cataract and Refractive Surgery) members. RESULTS: The duration of hospitalization has decreased annually and the use of topical anesthesia (49%) has hemained stationary. Self sealing wound construction was the main wound closure technique in phacoemulsification (66%). Acrylic intraocular lenses are the most preferred (75%) for small incisioncataract surgery. The implantation of phakic IOL was performed by 30% of respondents and interests in the value added by IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.
Anesthesia ; Cataract* ; Surveys and Questionnaires ; Hospitalization ; Korea* ; Lenses, Intraocular ; Phacoemulsification ; Postal Service ; Refractive Surgical Procedures ; Wound Closure Techniques ; Wounds and Injuries