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Achieving closure

Article-Achieving closure

Key iconKeypoints:

  • Current wound closure technology may reduce skin trauma and potential for infection
  • Despite the evolution of wound closure technology, some surgeons still prefer the classical approach of nonabsorbable sutures for surface wound closure
  • Two surgeons share their preferences for noninvasive approaches to superficial wound closure

Dr. Linder
NATIONAL REPORT — Stuart Linder, M.D., F.A.C.S., whose Beverly Hills plastic surgery clientele includes film industry icons, uses Steri-Strip Skin Closure (3M), for the superficial closure of surgical incisions. Z. Paul Lorenc, M.D., F.A.C.S., whose Park Avenue practice attracts a broad spectrum of successful, self-made, determined professionals, is an advocate of DERMABOND (Ethicon) for closure.

Dr. Lorenc
DRIVING THE EVOLUTION In a decade that has seen a drop in the average age of patients seeking plastic surgery to the early to mid-career level, the evolution of wound closure technology has been driven by patient expectations for a more expeditious recovery. Patients want good cosmetic results, but they also want to resume full activity after surgery, without needing additional office visits simply to remove staples or sutures. The noninvasive approach to superficial wound closure should also have a natural appeal for surgeons such as these because of reduced skin trauma and less potential for infection. Yet some of their surgical peers don't embrace the technology of tissue adhesives or topical devices, preferring the classical approach of nonabsorbable sutures for surface wound closure.

"New technology is wonderful provided that we can deliver the same quality of care that we have given in the past or better," Dr. Lorenc tells Cosmetic Surgery Times.

LIQUID OR DEVICE? DERMABOND is a transparent liquid skin adhesive containing 2-octyl cyanoacrylate, which was approved in 1998 for the superficial closure of surgical incisions in conjunction with, but not in place of, subcuticular sutures. DERMABOND is administered by applicator to the wound edges, which are manually approximated by fingertips or forceps, waiting 30 seconds between each of three thin layers, and maintaining the manual approximation for around 60 seconds after the final layer. DERMABOND works best with a perfectly apposed wound edge and is not appropriate when there is a discrepancy in the wound edges. During application, the adhesive should not be allowed to enter the wound because the polymerized material could elicit a foreign body reaction. Interestingly, dr. Lorenc successfully used dermabond for a breast augmentation in a patient who was severely allergic to surgical tape.

3M Steri-Strip is a set of individual pieces of adhesive-based wound closure tape that can be used in conjunction with Mastisol (Ferndale Labs) or benzoin to close a low-tension wound or surgical incision. Steri-Strips may be used as an adjunct to suture closures for higher tension wounds, such as tummy tucks and breast lifts. The strips, which are connected with cross stays in a railroad track pattern, may be applied with a gloved hand or forceps in two lines parallel with the wound. If edges are not accurately apposed, the Steri-Strips over the affected area may be peeled off to reapproximate the wound.

The more recently developed 3M Steri-Strip S Surgical Skin Closure is a system of soft polyurethane adhesive pads and interlaced polyester filaments that are laid out over the wound. Steri-Strips are contraindicated where adhesion cannot be obtained, for example, an area where the skin is wet or moist or has oils, exudate or hair; and areas that have a lot of repetitive movement or high tension. Steri-Strips that become macerated in wet areas, such as the suprapubic region, should be replaced with dry gauze.

According to Dr. Linder, it is important to note that allergy to adhesives can be an issue. He has seen a case of allergy — unknown prior to surgery — which produced severe blistering and left areas of hyperpigmentation.

VOICE OF EXPERIENCE Dr. Linder has performed thousands of body-sculpting procedures — breast augmentations, breast lifts, breast reductions, body contour, liposuctions and abdominoplasty — and he has used traditional steri-strips as a fourth closure layer for virtually every one.

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