Akahori Makoto, Sakai Shigeki, Kishi Kazuo
From the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2025 Jan 16;13(1):e6143. doi: 10.1097/GOX.0000000000006143. eCollection 2025 Jan.
Subcutaneous indwelling of nonabsorbable threads for tissue fixation and tension reduction is often used in plastic surgery and is applied in breast reduction surgery, umbilicoplasty, and in frontalis muscle lifting for congenital ptosis. However, in a few cases, exposure of the indwelling thread necessitates its removal. Exposure of the indwelling threads mostly occurs due to exposure of the knots. Therefore, we require a novel method to ensure that the knot of the indwelling thread remains unexposed. Hence, we created a stab incision to place the indwelling nonabsorbable threads ligated with moderate tensile force. Furthermore, we attached needles to each end of the ligated thread. The needles penetrated from the stab incision through the depths to separate sites farther away from each other. Finally, we towed and cut the exposed thread from the skin. Thus, the knots on the indwelling thread may be positioned deeper, reducing the risk of exposure to the indwelling thread. Furthermore, the risk of overcorrection is reduced as each end of the indwelling threads penetrates a different site. In addition, this method leaves certain length of the end of the knot under the skin, which improves the visibility of the indwelling thread during revision surgery, facilitates access, and reduces the operative time. Application of this method in subcutaneous indwelling of nonabsorbable threads may reduce complications and time required for revision surgery.
不可吸收缝线皮下留置用于组织固定和减张，常用于整形外科，如乳房缩小术、脐成形术以及先天性上睑下垂的额肌悬吊术。然而，在少数情况下，留置缝线外露需要将其取出。留置缝线外露大多是由于线结外露所致。因此，我们需要一种新方法来确保留置缝线的线结不外露。于是，我们做了一个小切口来放置以适度拉力结扎的不可吸收留置缝线。此外，我们在结扎线的两端各连接一根针。针从小切口穿入深部至彼此相距较远的不同部位。最后，将外露的缝线从皮肤处拖出并剪断。这样，留置缝线上的线结可更深地置于皮下，降低了留置缝线外露的风险。此外，由于留置缝线的两端穿入不同部位，过度矫正的风险也降低了。另外，这种方法在皮下留下一定长度的线结末端，提高了翻修手术时留置缝线的可视性，便于操作，减少了手术时间。将此方法应用于不可吸收缝线皮下留置可减少并发症及翻修手术所需时间。
