Tremolada C, Blandini D, Beretta M, Mascetti M
Department of Plastic Surgery, Ospedale Maggiore di Lodi, Milan, Italy.
Plast Reconstr Surg. 1997 Jul;100(1):126-31. doi: 10.1097/00006534-199707000-00023.
We report the use of a subcuticular purse-string suture for closure of surgical skin defects, a simple maneuver that we have found to be very useful in closing difficult wounds and reducing scarring. The purse-string suture is performed with a large nonabsorbable suture that is passed intradermally and left in situ at least 4 weeks. This technique has been applied in 196 patients for a total of 221 sutures over a period of 2 years, being used to close skin defects from 2 x 2 to 8 x 11 cm in many areas of the body. All the patients showed, at closure, a large number of concentric redundant folds as well as considerable distortion of nearby structures; both improved impressively over a period of 2 to 3 weeks and became nearly normal at the time of suture removal (4 to 8.2 weeks, mean 5.7 weeks). The initially very limited and almost circular scar oriented itself along the skin tension lines over a period of a few weeks and, when matured, was always shorter than the original defect. In general, minimal scar widening occurred when we used larger sutures (more than 0-1) that were left longer (more than 6 weeks). Complications have been 23 cases of dehiscence (10.4 percent) in 23 patients (between the fifth and sixteenth days, mean 6.7 days); they were caused by the bad quality of the skin and by the use of too small sutures that cut through the dermis. The "round block" suture has many advantages: 1. It is a simple, inexpensive, and rapid technique for closing wounds by expanding the surrounding skin and often avoiding the use of skin grafts and/or local flaps. 2. It can minimize scarring; the final scars are shorter than the original defect and usually of very good quality. 3. It allows a very useful temporary closure that stretches the surrounding skin while waiting for the definitive histologic report. If this method is not chosen as a definitive closure, later repair with local flaps may be facilitated. 4. For the reasons expressed above, it never compromises the final result even in cases of dehiscence. The main disadvantage is the acceptability of the method on the part of patients, who need to be carefully prepared for both the gross initial distortion and the long time the suture has to be retained; nevertheless, patient satisfaction with the final results in generally very high, especially in large excisions of the face.
我们报告了使用皮下荷包缝合术闭合手术皮肤缺损的情况，这是一种简单的操作，我们发现它在闭合难愈伤口和减少瘢痕形成方面非常有用。荷包缝合术使用一根大的不可吸收缝线进行，该缝线在真皮内穿过并原位留置至少4周。在2年的时间里，这项技术已应用于196例患者，共进行了221次缝合，用于闭合身体许多部位2×2至8×11厘米的皮肤缺损。所有患者在缝合时均出现大量同心冗余褶皱以及附近结构的明显变形；两者在2至3周内均有显著改善，在缝线拆除时（4至8.2周，平均5.7周）几乎恢复正常。最初非常有限且几乎呈圆形的瘢痕在几周内沿着皮肤张力线自行调整，成熟后总是比原来的缺损短。一般来说，当我们使用较大的缝线（大于0-1）且留置时间更长（超过6周）时，瘢痕增宽最小。并发症为23例患者出现23例裂开（10.4%）（在第5至16天之间，平均6.7天）；这是由皮肤质量差以及使用过小的缝线穿透真皮所致。“圆形阻滞”缝合术有许多优点：1. 它是一种通过扩张周围皮肤来闭合伤口的简单、廉价且快速的技术，常常可避免使用皮肤移植和/或局部皮瓣。2. 它可使瘢痕形成最小化；最终的瘢痕比原来的缺损短，且通常质量很好。3. 它能实现非常有用的临时闭合，在等待最终组织学报告的同时拉伸周围皮肤。如果不选择这种方法作为最终闭合方式，后期进行局部皮瓣修复可能会更便利。4. 由于上述原因，即使在裂开的情况下，它也不会影响最终结果。主要缺点是该方法在患者方面的可接受性，患者需要为最初明显的变形以及缝线必须留置的较长时间做好充分准备；然而，患者对最终结果的满意度通常非常高，尤其是在面部大切除术中。
