| Research background and significance:Scars in different degrees would be formed inevitably after the wound or surgical incision healed.The formation of scar is relevant to multiple factors,including the degree of loss,local inflammation,immune response,skin tension and so on,among which tension and the degree of scar after healing are closely related.Currently,how to fully reduce the tension and allow the incision to get fast and good healing and unobvious postoperative scar is still a challenging subject.In recent years,the studies on modified suture technology mainly focus on the treatment and prevention of pathological scars,namely,Keloid and hypertrophic scars,but few are focused on the relaxation degree of subcutaneous suture technology,as well as the evaluation and related comparative studies on degree of physiological scars.In this study,we proposed a new concept of incision distal subcutaneous relaxation suture and subcutaneous distal horizontal mattress relaxation suture technology,to demonstrate the reliable and lasting relaxation effect of the subcutaneous distal transverse mattress relaxation suture through comparative study between in vitro relaxation experiment and traditional relaxation suture technology.In the following study,we applied this relaxation suture technology in facial scar plasty,assessed and compared the appearance of postoperative scars of corresponding suture incision.We brought in the POSAS Scale(Patient and Observer Scar Assessment Scale),which is one of the latest and very popularly used scars assessment scale internationally in recent years,to observe and assess the long term condition of scars formed with the new suture technology we applied,and compared with the condition of scars formed by using traditional suture technology.Part ?Objective:To study the relaxation effect of subcutaneous distal transverse mattress relaxation suture on tensioned incision,within in vitro tension incision model,by observing the skin fissure and the direction of the skin texture post incision subcutaneous relaxation suture.Method:The in vitro skin incision specimens were prepared by using the excess skin through plastic surgery of the abdominal wall.The symmetrical specimens were divided into Group A and B.Subcutaneous embedded vertical mattress suture was performed in Group A;distal transverse mattress relaxation suture was performed in Group B:Inserted the needle from the subcutaneous fat side at approx.2 mm away from the incisal edge,hooked the basal dermal tissue to the laterosuperior direction,then turned to the lateroinferior direction,withdrew the needle at approx.1 cm way from the needle inserting site,back stitched from approx.1 cm adjacent to the needle withdraw site(the needle withdrawing site should be located at approx.1 cm away from the initial needle inserting site in the bottom of the incisal edge),performed a mirror operation at the contralateral side,then sutured and knotted.Exerted 2N,5N and 100 times of ?5N of periodical tension on two groups of incision specimens,respectively,then measured the width of skin fissure,fixed the direction of the tension,located near and took pictures,and observed the directions of the skin texture within approx.1 cm way from the bilateral incision through relief texture mapping technology.Result:Both groups of sutured incisions could match well,without fissure at the incisal edge.Skin fissure through 2N of tension,with width of approx.0.6-1.5mm,average width of approx.1.07 mm was observed in Group A;however,no skin fissure was observed in Group B,which still matched well.Skin fissure at the incision were widened,with width of approx.1.1-2.8mm,average width of approx.2.05 m through 5 N of tension was observed in Group A;however,minimal fissure was observed in only 4 specimens,with width of approx.0.1-0.4mm,average width of approx.0.08mm in Group B.All of the incision fissure was widened,with width of approx.3.2-6.5mm,average width of approx.4.84mm through 100 times of periodical 5 N tension in Group A;however,minimal fissure was observed in only 4 specimens,with width of approx.0.2-0.6mm,average width of approx.0.10 mm in Group B.The direction of skin textures were clearly observed in the incision after treatment of relief texture mapping technology.The skin texture was loosened within approx.1 cm of range,without obvious predominant direction in Group A;extension towards the direction of tension was observed adjacent to and within the periphery of approx.1 cm in both sides of Group B incisions.Conclusion for Part I:Distal subcutaneous transverse mattress relaxation suture can make incision with tension relaxation and folded.The distal subcutaneous transverse mattress relaxation suture can effectively keep the no tension status of folded incisal edge and bilateral skin adjacent to the incisal edge under no tension status in a relatively large range,no matter under static tension or periodical dynamics tension.Part ?Objective:To apply the distal subcutaneous transverse mattress relaxation suture technology in facial scar plasty,observe and evaluate the long term outcome of scars after using new suture technology,and compare with the outcome of scars after using traditional suture incision.Method:Chose patients having experienced facial scar one-time removal and multiple times removal suture as the study subjects randomly.The subjects were divided into the treatment group and control group.After removal of scars,the patients in treatment group undertook distal subcutaneous transverse mattress relaxation suture;the patients in the control group undertook subcutaneous embedded vertical mattress suture.Observed healing of incision at postoperative stitching.Followed up the condition of scars in 3,6 months post operation,measured the width of scars for each patient in both groups,and evaluated the score of POSAS Scale.Result:All incision folded tightly in eversion after suture.The incision bulged with more obvious eversion.The comparison in width of the scars:the average width of scars in 3 moths post operation was approx.1.02 mm vs.1.32mm in the treatment and control group,respectively.T-test were designed for both groups;the average width of scars 6 months post operation in the treatment group and control group was approx.1.25mm vs.1.66mm.The difference is of statistical significance(P<0.05).The score of POSAS 3 moths post operation:the average of sum of each scores in the treatment and control groups was 14.56 vs.18.91,while the overall impression scores were 2.94 vs.3.59,respectively.The difference of rank sum test is of statistical significance(P<0.05).The average values for the sum of each observer's score in the treatment and control group were 14.73 vs.16.85 respectively;while the overall impression scores in the treatment and control group were 1.94 vs.3.28,respectively.We compared the difference of the rank sum test of the measurement data designed,finding that the difference in average value for the sum of each score is of no statistical significance;however,the difference in overall impression score is of obvious statistical significance(p<0.05).The POSAS scale in 6 months post operation:the sum of each score and mean for the treatment and control group was 10.05 vs.14.76,and the overall impress score was 2.1 vs.2.96.We compared the difference of rank sum test of the measurement data designed(P<0.05),respectively.The observer assessed the sum of each score for the treatment group and control group,with their average value is 9.89 vs.13.33,overall impression score 1.61 vs.13.33.We compared the rank sum test difference of the measurement data designed,respectively.The difference in mean sum of each score and overall impression score is of obvious statistical significance(p<0.05).Conclusion for Part ?:When distal subcutaneous transverse mattress relaxation suture technology is applied in facial scar plasty,it can fully reduce the tension of the incision,and keep the incisal edge in good eversion and folding status,which could greatly reduce the suture in the dermis.The width of scars formed by the suture and the score of POSAS scar scale showed less degree of postoperative scar,and less uncomfortable symptoms like pruritus and pain as compared with traditional tension relaxation suture. |
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