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Surgeons Have Numerous Rhytidectomy Choices the Best Technique Should Balance the Efficacy of the Lift with a Low Rate of Suture Extrusion

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Surgeons Have Numerous Rhytidectomy Choices the Best Technique Should Balance the Efficacy of the Lift with a Low Rate of Suture Extrusion 40 Dermatologic Surgery S KIN & ALLERGY N EWS • March 2007 Surgeons Have Numerous Rhytidectomy Choices The best technique should balance the efficacy of the lift with a low rate of suture extrusion. BY KATE JOHNSON “With the loss of deep tissue support, Montreal Bureau there is an increase in wound tension and an increased risk of necrosis, scarring, P HOENIX — In the face of myriad trophic changes, and contour defect,” Dr. short-scar rhytidectomy techniques, su- Tanna said. ture extrusion rates and efficacy of lift are His retrospective study compared 1,850 two variables that can help surgeons iden- short-scar rhytidectomies performed by tify their preferred approach, Dr. Neil one surgeon between January 2002 and Tanna said at the annual meeting of the January 2006, with the primary outcome American Academy of Cosmetic Surgery. being the rate of suture extrusion. All pa- Although secure tients also received ANNA suspension of the Loss of deep tissue support cervicofacial liposuc- T superficial muscu- tion at the time of EIL . N means an increase in R loaponeurotic sys- the surgery and were D tem (SMAS) is indis- wound tension and an divided into six pensable for effective groups based on the increased risk of necrosis, OURTESY results, there are nu- type of SMAS plica- C merous SMAS sus- scarring, trophic changes, tion they underwent. This patient is undergoing the two-layer running locked superficial musculo- pension techniques In group A, 100 aponeurotic system plication with a braided, nonabsorbable suture. and no consensus on and contour defect. patients received O- which is superior, shaped purse-string used with a braided, nonabsorbable su- achieved the best overall outcome in terms said Dr. Tanna, who is a resident in oto- sutures (2-0 Ethibond). For the 100 pa- ture (2-0 Mersilene). of both lift and a low rate of suture ex- laryngology and head and neck surgery tients in group B, both O-shaped and U- After at least 6 months of follow-up, the trusion. at George Washington University in shaped purse-string sutures (2-0 Ethi- patients were compared in terms of rate, Although the study didn’t formally Washington. bond) were used. Interrupted horizontal type, and location of suture extrusion. “evaluate the efficacy of the achieved lift “Surgeon preference is usually based on mattress sutures were used for the 50 pa- Group A had a 5% rate of suture ex- while looking at suture extrusion ...anec- the efficacy of the achieved lift and the rate tients in group C (2-0 Ethibond), 50 pa- trusion, compared with 8% for group B, dotal experience suggests that the two-lay- of suture extrusion,” he said in an inter- tients in group D (2-0 Vicryl), and 50 pa- 6% for group C, and 1.2% for group F, re- er plication stitch employing a braided view, explaining that suture extrusion dis- tients in group E (2-0 Mersilene). Group ported Dr. Tanna. Although groups D nonabsorbable suture allows an effective rupts the biomechanical properties of the F included 1,500 patients in whom a two- and E had no suture extrusions, he con- SMAS suspension with a tolerable rate of manipulated tissue. layer running locked plication stitch was cluded that patients in group F had suture extrusion,” he said. ■ Laparoscopic Technique Can Release Large Subcutaneous Scars BY KATE JOHNSON diameter liposuction cannulas or V-tip dissector can- Montreal Bureau nulas, Dr. Pelosi said. However, more complicated scars that involve the aponeurosis cannot be eliminat- P HOENIX — Large, depressed abdominal scars that ed using these tools. complicate liposuction can be safely removed using “a In a study of 20 consecutive patients who required novel technique” involving standard laparoscopic scis- release of such depressed abdominal scars prior to of- sors, Dr. Marco A. Pelosi II said at the annual meeting fice liposuction, standard laparoscopic scissors were safe of the American Academy of Cosmetic Surgery. and effective, reported Dr. Pelosi, who is a gynecolo- The technique has no laparoscopic component, he gist in Bayonne, N.J. said in an interview, and following his success with stan- Computed axial tomography scans of all scars were dard laparoscopic scissors in this study, he has since de- performed preoperatively to rule out incisional hernias, signed the Pelosi Liposcar scissors, which are specifi- and all surgeries were performed under tumescent cally intended for this purpose. anesthesia. Surgical scars that do not involve direct adherence of The laparoscopic scissors were introduced through the dermis to the muscle fascia are relatively simple to a 3- to 4-mm incision parallel to the skin surface in manage at the time of liposuction using either small- the superficial subcutaneous layer and advanced to- ward the scar. As soon as fibrotic resis- This depressed scar, caused by three previous laparotomies, tance was encountered, the operator’s can be released with standard laparoscopic scissors. Number of Selected Inpatient free hand was used to stabilize the area Procedures in 2004 while the other hand moved the scissors in “a lancing and fanning motion” to cut the subcutaneous fibrotic strands, Dr. Cardiovascular system 6,993,000 Pelosi explained. Digestive system 5,824,000 The scissors were then directed into the II Musculoskeletal system 4,040,000 deep dermis to cut the fibrotic strands at- ELOSI Integumentary system 1,498,000 EWS tached to the muscle fascia. Finally, the N scissors were used to feel and release any A. P Nervous system 1,291,000 remnants of fibrotic tissue holding the EDICAL ARCO Respiratory system 1,045,000 M scar. After full release of the scar, standard . M Urinary system 963,000 R liposuction was performed. D LOBAL Nose, mouth, and pharynx 309,000 G Complete release of the scar was Eye 71,000 achieved in all of the study subjects with- LSEVIER out any intraoperative or postoperative Ear 45,000 /E complications. HOTOS COURTESY P ELLER At 12 months post procedure there was Source: National Center for Health Statistics K no evidence of recurring subcutaneous fi- The scar has been safely and fully released in preparation ULIE ■ J brotic strands, he said. for liposuction..
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