Volume 27, Issue 6 (8-2020)
RJMS 2020, 27(6): 9-17 |
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Jahandideh H, Roomiani M. Suture materials usage in rhinoplasty: Survey on behavior. RJMS 2020; 27 (6) :9-17
URL: http://rjms.iums.ac.ir/article-1-6162-en.html
URL: http://rjms.iums.ac.ir/article-1-6162-en.html
ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran, & Department of Otolaryngology-Head and Neck Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran , maryam.roomiani@yahoo.com
Abstract: (2767 Views)
Background: Rhinoplasty is among the most requested plastic surgeries. As the surgery site is on the face and some of these surgeries only performed for aesthetic purposes, suture techniques are mainstay of these procedures. Traditionally, non-absorbable sutures such as nilon sutures were used. However, complications of these materials, alongside introduction of new absorbable materials have changed the trends and many surgenos prefer to use absorbable sutures, in most of their operations. It is reported that tensile strength of the suture, the probability of infection, besides its usability in grasping the tissues during different rhinoplasty maneuvers are among the factors, yielding to the decision of the surgen. There are currently some standard protocols in techniques of suturing during a standard rhinoplasty operation. However, there is no consensus on the type of suture, absorbable or non-absorbable one, for these operations. Recent studies have claimed that in spite of using non-absorbable sutures for suturing nose tip, high rates of complications and side-effects, besided non-inferiority of the absorbable suture in comparison with the non-absorbable ones, due to evidence, current trend is using absorbable sutures for this purpose. The aim of this study was to determine the pattern and frequency of using absorbable or non-absorbable sutures among rhinoplasty surgeons and their experienced side-effects and complications due to their usage.
Methods: In this survey on behavior, a 10-item questionnaire was used for data collection. The questionnaire was filled by a face-to-face interview with ENT surgens, attending at the Yearly Conference of ENT Surgens. Years of surgeons’ experience, number of monthly operations, types of suture materials, type and frequency of complications they have faced, while using these suture materials, and whether the brand of the suture is important to them or not was asked and recorded. The data were then registered in computer and analysed using IBM SPSS 22.0 for descriptive and analytical reports and graphs.
Results: Totally 100 ENT surgeons were interviewed, with mean 15.5 years of experience in rhinoplasty surgery. The interviewed surgens reported that in average, they had 20 surgeries monthly (range of 5 to 90). In tip plasty, 52 surgeons exclusively were using absorbable PDS sutures, 32 exclusively were using non-absorbable nylon sutures, and 16 of them were using mixed sutures in different sureries. 66 percent of surgens, preferring non-absorbable nylon suture reported that they had at least one complication in using such type of suture. 76% of the complications were due to abscess formation, 22% was related to suture extrusion, and 9% reported skin reaction on the suture site. On the other hand, only 15 percent of the surgens using absorbable PDS sutures reported the experience of facing complication in suture. Among them, there were 7 cases of abscess formation, 3 cases of suture extrusion, and one case with skin reaction in suture site. All of the complications, reported by doctors using mixed absorbable and non-absorbable sutures had happened in cases of using non-absorbable suture, which were abscess formation in 7 cases, and suture extrusion in 2 cases. In more than half of participants, the brand of suture was not important and This insignificance of suture brand was not related to neither years of rhinoplasty experience (t test p-value = 0.12), nor the number of surgeries (t test p-value=0.525), performed in month.
78 of the surgens used vicryl, 13 used chromic, and 1 used monocryl sutures for septum sutures. 17 of these experts had experiences of complication in septum suture: 9 for chromic suture and 8 for vicryl suture. In these cases, sense of bad smell (in 11 cases), abscess formation (in 5 cases), and granulation tissue formation (in 1 case) were among the complications.
Conclusion: It seems that a majority of Iranian rhinoplasty surgens prefer using absorbable sutures in their rhinoplasty surgeries. As the responses suggest, surgens using absorbable PDS sutures are facing less complications than those using non-absorbable nylon suture. Moreover, most of the surgenos, interviewed in this study did not pay attention to the brand of the suture they are using, which was not related to the years of experience in rhinoplasty or the number of the surgeries they perform in month.
In addition to nose tip suture, a majority of the experts were using vicryl suture for suturing the septum in their surgeries. However, there were no significant difference in the number of complications, experienced with chromic or vicryl sutures. Most of the complications were due to a sense of bad smell, abscess formation, and granulation tissue formation in one case. Additionally, no case of septal necrosis was reported by the experts.
Methods: In this survey on behavior, a 10-item questionnaire was used for data collection. The questionnaire was filled by a face-to-face interview with ENT surgens, attending at the Yearly Conference of ENT Surgens. Years of surgeons’ experience, number of monthly operations, types of suture materials, type and frequency of complications they have faced, while using these suture materials, and whether the brand of the suture is important to them or not was asked and recorded. The data were then registered in computer and analysed using IBM SPSS 22.0 for descriptive and analytical reports and graphs.
Results: Totally 100 ENT surgeons were interviewed, with mean 15.5 years of experience in rhinoplasty surgery. The interviewed surgens reported that in average, they had 20 surgeries monthly (range of 5 to 90). In tip plasty, 52 surgeons exclusively were using absorbable PDS sutures, 32 exclusively were using non-absorbable nylon sutures, and 16 of them were using mixed sutures in different sureries. 66 percent of surgens, preferring non-absorbable nylon suture reported that they had at least one complication in using such type of suture. 76% of the complications were due to abscess formation, 22% was related to suture extrusion, and 9% reported skin reaction on the suture site. On the other hand, only 15 percent of the surgens using absorbable PDS sutures reported the experience of facing complication in suture. Among them, there were 7 cases of abscess formation, 3 cases of suture extrusion, and one case with skin reaction in suture site. All of the complications, reported by doctors using mixed absorbable and non-absorbable sutures had happened in cases of using non-absorbable suture, which were abscess formation in 7 cases, and suture extrusion in 2 cases. In more than half of participants, the brand of suture was not important and This insignificance of suture brand was not related to neither years of rhinoplasty experience (t test p-value = 0.12), nor the number of surgeries (t test p-value=0.525), performed in month.
78 of the surgens used vicryl, 13 used chromic, and 1 used monocryl sutures for septum sutures. 17 of these experts had experiences of complication in septum suture: 9 for chromic suture and 8 for vicryl suture. In these cases, sense of bad smell (in 11 cases), abscess formation (in 5 cases), and granulation tissue formation (in 1 case) were among the complications.
Conclusion: It seems that a majority of Iranian rhinoplasty surgens prefer using absorbable sutures in their rhinoplasty surgeries. As the responses suggest, surgens using absorbable PDS sutures are facing less complications than those using non-absorbable nylon suture. Moreover, most of the surgenos, interviewed in this study did not pay attention to the brand of the suture they are using, which was not related to the years of experience in rhinoplasty or the number of the surgeries they perform in month.
In addition to nose tip suture, a majority of the experts were using vicryl suture for suturing the septum in their surgeries. However, there were no significant difference in the number of complications, experienced with chromic or vicryl sutures. Most of the complications were due to a sense of bad smell, abscess formation, and granulation tissue formation in one case. Additionally, no case of septal necrosis was reported by the experts.
Type of Study: Research |
Subject:
ENT Surgery
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