Absorbable versus Non-Absorbable Sutures in Paediatric Facial Trauma - A Cosmetic Assessment

Paediatric age group is most vulnerable to trauma. Children often suffer facial injuries. Though many topical skin adhesives and strips are available in the market which have given excellent cosmetic results, deeper injuries especially along the lines of high tension need suturing both with buried and skin sutures. Different variety of sutures are available in the market which are used as per the choice of the surgeon. Children are more apprehensive when it comes to suture removal. So use of absorbable sutures in place of non-absorbable sutures in skin can save the children from this fear factor. MethodsA prospective study was done in the department of plastic surgery from May 2012 to Dec. 2013 with an objective of studying the outcome of plain catgut suture as skin sutures versus non-absorbable skin suture Nylon in facial trauma in the paediatric age group. Chromic catgut was used as buried suture in both groups. All the patients presenting in emergency department with facial trauma with age 10 years or less were included in the study. Skin sutures, where needed removal, were removed on 5th post-operative day followed by follow up on 7th post-operative day, 3rd month and 8th month during which cosmetic assessment of scar was done. 25 patients who presented first in emergency and fulfilled the study criteria were sutured with 5 - 0 chromic catgut buried sutures and skin suture used was 6 - 0 Nylon and this group was labelled group A. Next 25 patients who presented in emergency for suturing were sutured with 5 - 0 chromic catgut as buried and plain catgut as skin suture. This group was labelled as Group B. Cosmetic outcome was assessed on 7th post-operative day, 3rd month and 8th month by using Beusang E cosmetic scar assessment scale based on two parameters which included colour and texture of scar.1 Statistical analysis was done with continuous variables expressed as Mean ± S.D. and categorical variables were expressed as count (percentage). Chi-square was used to compare the categorical variables between groups or Fisher exact test was used. ResultsOn 7th post-operative day follow up, out of 50 patients, 25 patients (50 %) in whom nylon was used as skin suture, 4 patients (16 %) had mismatch of colour. All scars were smooth in texture. In rest 25 patients (50 %) in whom plain catgut was used as a skin suture, 1 (4 %) patient had mismatch of the colour. None of the patients had frank pus in both groups & hypertrophic scar was seen in one patient. On 3rd month follow up, Group A patients with nylon as skin suture, 1 (4 %) patient showed hypertrophic scar whereas in Group B (8 %) patients had hypertrophic scar. On 8th month follow up, both group A & B had colour mismatch of 12% with firm texture of scar in 8% patients. ConclusionsThere is no long-term differences in cosmetic outcomes and complication rates between absorbable catgut suture and commonly used nylon sutures in the repair of facial trauma in paediatric age groups. So, absorbable sutures are acceptable alternative to non-absorbable suture especially in paediatric age group, keeping in mind their apprehensive nature and fear of suture removal.

Polydioxanone as Buried Suture in Facial Trauma - A Prospective Study.

Irrespective of cause of injury, facial scars are always considered as a stigma causing both mental and social disgrace to the victim. The principle aim of any suturing is to produce aesthetically pleasing scar. Besides surgical skills, the choice of suture material also plays a very important role in getting a good scar. Though suture material used for suturing is mostly Nylon everywhere, it’s the buried sutures which obliterate the dead space and reduce wound tension which make the real difference in the appearance of scar. Sutures of different types are today available & the operating surgeon uses the best suture material for the patient in a given circumstance based on his personal experience, scientific observations, & manufacturer’s advice.1 METHODSThis is a prospective study conducted in the department of plastic surgery at Christian Medical College, Ludhiana from May 2012 to April 2013. The study included all the patients of facial trauma registered during that period of one year. Demographic profile was noted along with the cause of trauma. A well-informed consent was taken. In our study skin approximation was done by either 5-0 or 6-0 Nylon suture. Buried suture used in all was Polydioxanone (PDS) 5-0. Skin sutures were removed on 5th POD. Beusang Clinical Scar assessment scale2 was used in the study to assess scar appearance. Patients were followed every month for 5 months after removal of skin sutures. The parameters noted included, colour, contour, matte/shine, and texture of scar. Photographic record of the patients was maintained. Statistical analysis was done using McNemar test. RESULTSOut of the 40 patients in our study, road traffic accidents constituted 85 percent of facial trauma, rest included fall on floor. M:F ratio was 3:1. With Polydioxanone as buried suture, 35 patients (87.5%) had normal texture, 30 patients (75%) had Matte appearance of the scar, 20 patients (50%) had no distortion of scar, 25 patients (62.5%) had perfect match of colour with hypertrophic scar noticed in 4 patients (0.1%). CONCLUSIONSPolydioxanone as buried suture gave aesthetically pleasing scar which improved in appearance during the follow up periods. There was significant statistical improvement in scar appearance starting from 5th day of suture removal to assessment at 5 months. No discharge from the wound site was noted in any of the patients. Hypertrophic scars noticed were later treated with steroid injection

Uterine Perforation with Bowel Infarction in a case of Unsafe Abortion.

We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.

Application of Alvarado Scoring System in Diagnosis of Acute Appendicitis.

This is a prospective study to assess the accuracy of the Alvarado Scoring System in predicting acute appendicitis in our set up.100 consecutive patients with suspected acute appendicitis were included in the study. They were given specific scores according to variables of Alvarado scoring system and then divided into 3 groups. Group A included patients with score of 7 or more and they underwent surgery, Group B included patients with score of 5-6 and they were admitted for observation and Group C included patients with score of 4 or less and they were discharged after symptomatic treatment. Patients from group B with increased symptom intensity (score 7 or more) in re-evaluation underwent surgery. Diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by calculating negative appendectomy rate and positive predictive value .Out of a total of 100 patients 74 underwent surgery and appendicitis was confirmed by histopathological examination in 62 patients, thus giving negative appendectomy rate of 16.21% and positive predictive value of 83.79%.Alvarado Scoring System is a simple, easy and reliable tool in the diagnosis of acute appendicitis.