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Alternative to tissue expanders offers versatility

Helsinki, Finland — An alternative to the bulky and often unsightly tissue expanders used for coverage of burns, prevention scar widening and scalp reductions could be on the horizon for American doctors. The Nordstrom Suture is already approved in Europe and elsewhere around world and is about to enter the Food and Drug Administration approval process.

Rolf E.A. Nordstrom, M.D., of Helsinki, Finland, developed the suture, which he says avoids some of the most common problems caused by using the large tissue expanders.

Suture nature

The suture is made of medical-grade silicon, currently made in 1.0 mm and 1.5 mm diameters, which has 400 percent elasticity.

"That means you can stretch the silicon to four times its natural length. It is attached to a needle and used like a suture — tied in the usual manner with square knots," Dr. Nordstrom explains.

The tension the suture places on the skin draws the tissues together as the silicon returns to its normal length. Dr. Nordstrom explains that the suture offers more versatility than the expanders, because the tension can be adjusted in various directions and by varying amounts.

Indications for use

Some of the primary indications for using the suture, according to Dr. Nordstrom, are serial reduction — to remove a giant nevus or bald spot, cover a burn scar or prevent scar widening.

"If you have an area where you still get a wide scar despite meticulous suturing — I'm not talking about hypertrophic scars or keloids, simply scars widening because of the tension of healing — then you have a much better chance of getting a better scar when you use the suture," Dr. Nordstrom explains.

"This gives you a suture you can leave in or remove it, whichever you prefer. That's one of the other advantages of the Nordstrom Suture. It reduces the need for follow-up surgery required by tissue expanders. In Europe, the suture material is approved as a substance that can be left under the skin after surgery. If the physician wants to remove it, that is easily done."

The suture can be attached originally with an absorbable suture, then when that dissolves, the silicon can simply be pulled through the skin, or it can be tied to itself percutaneously like a polypropylene suture.

Dr. Nordstrom says scar-widening can occur on a regular basis for cosmetic surgeons, and in a number of specific areas, this suture can resolve the issue to the surgeons' and the patients' satisfaction.

"We use it for situations like a burn on the neck. If the patient has a longitudinal scar in the shoulder area along the arm — that's an area where you easily get a wide scar. Another area, for example, is the leg, particularly in the hip area. On the lateral side, a longitudinal scar along the leg very easily widens out, despite good suturing. Also, vertical scars in the abdominal area — not horizontal scars; horizontal scars usually give you a better scar — the vertical scars in the abdominal area can give you a wide scar in many patients."

Complications

One potential complication is that the suture can pull through tissues that are too weak to hold it, so doctors need to be careful during placement of the suture.

Dr. Nordstrom, who is chief of the Nordstrom Hospital, says that after seeing tissue expanders used to create pockets for breast implants in the United States, he took the technology home and started using it for scalp reductions and did a number of studies on tissues.

"During that process, I found that tissue expanders are not always the best solution. I thought there should be an easier, cheaper and less disfiguring way of creating the mechanical and biological creep — which is what you create with tissue expansion. I came up with the idea of the suture and was surprised that I couldn't find anything like it anywhere," Dr. Nordstrom says.

Dr. Nordstrom now holds the worldwide patent on the suture, and is looking forward to bringing the technology to the United States.

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