Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study

Peiru Min; Shunuo Zhang; Dorsa Gholamali Sinaki; Ping Yao; Fuhua Hu; Xin Wang; Danya Zhou; Jun Chai; Yixin Zhang

doi:10.1093/burnst/tkad026

您当前的位置：

首页 >

文章列表页 >

Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study

更新时间：2023-08-29

- Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study
- Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study
- Burns & Trauma 2023年11卷第1期
- 作者机构：
  
  1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
  2. Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital
  3. Department of Plastic and Reconstructive Surgery, Ningbo Sixth Hospital
  4. Department of Burns and Plastic Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
- 作者简介：
- 基金信息：
  
  This study was supported by the National Natural Science Foundation of China (grant number: 82172222), the Outstanding Professional and Technical Leader Program of the Shanghai Municipal Science and Technology Commission (18XD1423700), the Shanghai Health Industry Clinical Research Special Project (20204Y0443), the Cross Research Project of Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (JYJC202009) and Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant number: 20152227).
- DOI：10.1093/burnst/tkad026
  中图分类号：
- 纸质出版日期：2023，
  
  网络出版日期：2023-6-15，
扫描看全文
Peiru Min, Shunuo Zhang, Dorsa Gholamali Sinaki, 等. Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study[J]. Burns & Trauma, 2023,11(1).

Peiru Min, Shunuo Zhang, Dorsa Gholamali Sinaki, Ping Yao, Fuhua Hu, Xin Wang, Danya Zhou, Jun Chai, Yixin Zhang, Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study, Burns & Trauma, Volume 11, 2023, tkad026, https://doi.org/10.1093/burnst/tkad026
Peiru Min, Shunuo Zhang, Dorsa Gholamali Sinaki, 等. Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study[J]. Burns & Trauma, 2023,11(1). DOI： 10.1093/burnst/tkad026.

Peiru Min, Shunuo Zhang, Dorsa Gholamali Sinaki, Ping Yao, Fuhua Hu, Xin Wang, Danya Zhou, Jun Chai, Yixin Zhang, Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study, Burns & Trauma, Volume 11, 2023, tkad026, https://doi.org/10.1093/burnst/tkad026 DOI：

摘要

Abstract

BackgroundAn ideal tension-relieving suture should be efficient for >3 months to retrieve normal tensile strength. Most preexisting suturing techniques provided tension elimination followed by relapse and scar proliferation due to absorption and cut-through of the sutures. This study introduces a simple but effective suture technique developed by a senior author (ZYX) to solve this problem.MethodsA total of 120 patients with pathological scar (PS) had intervention treatment with the proposed suturing strategy at three centers from January 2018 to January 2021. A slowly absorbable 2–0 barbed suture was used for subcutaneous tension relieving with a set-back from the wound edge and a horizontal interval between proposed inserting points of 1 cm. The Patient and Observer Scar Assessment Scale (POSAS)

scar width

perfusion and eversion of the wound edge were evaluated at 3-

6- and 12-month follow-up. The time needed to place the tension-relieving suture was recorded and relapse was monitored for 18 months postoperatively.ResultsIn total

76 trunks

32 extremities and 12 cervical PS were included

with an average subcutaneous tension-relieving suture time of 5 min. The Patient and Observer Scar Assessment Scale (POSAS) score decreased from 84.70 ± 7.06 preoperatively to 28.83 ± 3.09

26.14 ± 1.92 and 24.71 ± 2.00 at 3

6 and 12 months postoperatively

respectively (p < 0.0001). The scar widths were 0.17 ± 0.08

0.25 ± 0.09 and 0.33 ± 0.10 cm

respectively

with perfusion significantly decreased from 213.64 ± 14.97 to 112.23 ± 8.18 at 6 months (p < 0.0001). The wound edge flattened out during the first 3 months in most cases with only two scar relapses.ConclusionsZhang’s suture technique provides a rapid and long-lasting tension-relieving effect with ideal scar appearances and lower relapse rates in the surgical management of PS.

关键词

Keywords

Pathological scarTension-relievingSuture techniqueTension

references

1.Clark JA, Cheng JC, Leung KS. Mechanical properties of normal skin and hypertrophic scars. Burns. 1996;22:443–6.

2.Madden JW, Peacock EE, Jr. Studies on the biology of collagen during wound healing. 3. Dynamic metabolism of scar collagen and remodeling of dermal wounds. Ann Surg. 1971;174:511–20.

3.Silver FH, Siperko LM, Seehra GP. Mechanobiology of force transduction in dermal tissue. Skin Res Technol. 2003;9:3–23.

4.Ogawa R, Okai K, Tokumura F, Mori K, Ohmori Y, Huang C, et al. The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation. Wound Repair Regen. 2012;20:149–57.

5.Levenson SM, Geever EF, Crowley LV, Oates JF, 3rd, Berard CW, Rosen H. The healing of rat skin wounds. Ann Surg. 1965;161:293–308.

6.Jacquet E, Josse G, Khatyr F, Garcin C. A new experimental method for measuring skin's natural tension. Skin Res Technol. 2008;14:1–7.

7.Gennisson JL, Baldeweck T, Tanter M, Catheline S, Fink M, Sandrin L, et al. Assessment of elastic parameters of human skin using dynamic elastography. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:980–9.

8.Harn HI, Ogawa R, Hsu CK, Hughes MW, Tang MJ, Chuong CM. The tension biology of wound healing. Exp Dermatol. 2019;28:464–71.

9.Ogawa R. Mechanobiology of scarring. Wound Repair Regen. 2011;19:s2–9.

10.Ogawa R, Hsu CK. Mechanobiological dysregulation of the epidermis and dermis in skin disorders and in degeneration. J Cell Mol Med. 2013;17:817–22.

11.Regula CG, Yag-Howard C. Suture products and techniques: what to use, where, and why. Dermatol Surg. 2015;41:S187–200.

12.Barnes LA, Marshall CD, Leavitt T, Hu MS, Moore AL, Gonzalez JG, et al. Mechanical forces in cutaneous wound healing: emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle). 2018;7:47–56.

13.Ogawa R, Akaishi S, Huang C, Dohi T, Aoki M, Omori Y, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch. 2011;78:68–76.

14.Zitelli JA, Moy RL. Buried vertical mattress suture. J Dermatol Surg Oncol. 1989;15:17–9.

15.Kantor J. The running butterfly suture: a novel, everting alternative to the running subcuticular technique. J Am Acad Dermatol. 2016;74:e19–20. https://doi.org/10.1016/j.jaad.2015.08.025.

16.Kantor J. The set-back buried dermal suture: an alternative to the buried vertical mattress for layered wound closure. J Am Acad Dermatol. 2010;62:351–3.

17.Wang LZ, Ding JP, Yang MY, Chen B. Forty-five cases of chest keloids treated with subcutaneous super-tension-reduction suture combined with postoperative electron-beam irradiation. Dermatol Surg. 2014;40:1378–84.

18.Zhang X, Diao JS, Guo SZ, Han Y, Ai YF, Zeng XH, et al. Wedge-shaped excision and modified vertical mattress suture fully buried in a multilayered and tensioned wound closure. Aesthet Plast Surg. 2009;33:457–60.

19.Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg. 2007;59:688–91.

20.Guidelines for the clinical Management of Keloid in China [in Chinese]. Chin J Aesth Plast Surg. 2018;29:245–56.

21.Ogawa R, Tosa M, Dohi T, Akaishi S, Kuribayashi S. Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal. 2019;5:2059513119891113. https://doi.org/10.1177/2059513119891113.

22.Tsuge T, Aoki M, Akaishi S, Dohi T, Yamamoto H, Ogawa R. Geometric modeling and a retrospective cohort study on the usefulness of fascial tensile reductions in severe keloid surgery. Surgery. 2020;167:504–9.

23.Dohi T, Kuribayashi S, Tosa M, Aoki M, Akaishi S, Ogawa R. Z-plasty and postoperative radiotherapy for upper-arm keloids: An analysis of 38 patients. Plast Reconstr Surg Glob Open. 2019;7:e2496. https://doi.org/10.1097/GOX.0000000000002496.

24.Arima J, Dohi T, Kuribayashi S, Akaishi S, Ogawa R. Z-plasty and postoperative radiotherapy for anterior Chest Wall keloids: An analysis of 141 patients. Plast Reconstr Surg Glob Open. 2019;7:e2177. https://doi.org/10.1097/GOX.0000000000002177.

25.Kal HB, Veen RE, Jürgenliemk-Schulz IM. Dose-effect relationships for recurrence of keloid and pterygium after surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2009;74:245–51.

26.van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 2005;116:514–22.

27.Burusapat C, Wanichjaroen N, Wongprakob N, Sapruangthong R. The effectiveness of immediate triamcinolone Acetonide injection after auricular keloid surgery: a prospective randomized controlled trial. Plast Reconstr Surg Glob Open. 2021;9:e3729. https://doi.org/10.1097/GOX.0000000000003729.

28.Wang PH, Huang BS, Horng HC, Yeh CC, Chen YJ. Wound healing. J Chin Med Assoc. 2018;81:94–101.

29.Kimura S, Tsuji T. Mechanical and immunological regulation in wound healing and skin reconstruction. Int J Mol Sci. 2021;22:5474.

30.Wong VW, Akaishi S, Longaker MT, Gurtner GC. Pushing back: wound mechanotransduction in repair and regeneration. J Invest Dermatol. 2011;131:2186–96.

31.Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–71.

32.Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg. 2003;111:547–55.

33.Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014;29:751–7.

34.Grabowski G, Pacana MJ, Chen E. Keloid and hypertrophic scar formation, prevention, and management: standard review of abnormal scarring in orthopaedic surgery. J Am Acad Orthop Surg. 2020;28:e408–14. https://doi.org/10.5435/JAAOS-D-19-00690.

35.Liu Z, Tang Z, Hao X, Liu X, He L, Yu X, et al. Modified buried vertical mattress suture versus buried intradermal suture: a prospective split-scar study. Dermatol Surg. 2021;47:e75–80. https://doi.org/10.1097/DSS.0000000000002642.

36.Hong JP, Chung IW. The superficial fascia as a new plane of elevation for anterolateral thigh flaps. Ann Plast Surg. 2013;70:192–5.

37.Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124:1529–44.

38.Crewe C, An YA, Scherer PE. The ominous triad of adipose tissue dysfunction: inflammation, fibrosis, and impaired angiogenesis. J Clin Invest. 2017;127:74–82.

39.Stavrou D. Neovascularisation in wound healing. J Wound Care. 2008;17:298–302.

40.Brown NJ, Smyth EA, Cross SS, Reed MW. Angiogenesis induction and regression in human surgical wounds. Wound Repair Regen. 2002;10:245–51.

41.Kappel S, Kleinerman R, King TH, Sivamani R, Taylor S, Nguyen U, et al. Does wound eversion improve cosmetic outcome?: results of a randomized, split-scar, comparative trial. J Am Acad Dermatol. 2015;72:668–73.

42.Wang AS, Kleinerman R, Armstrong AW, Fitzmaurice S, Pascucci A, Awasthi S, et al. Set-back versus buried vertical mattress suturing: results of a randomized blinded trial. J Am Acad Dermatol. 2015;72:674–80.

43.Zaruby J, Gingras K, Taylor J, Maul D. An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. Aesthet Surg J. 2011;31:232–40.

44.Wray RC. Force required for wound closure and scar appearance. Plast Reconstr Surg. 1983;72:380–2.

45.Pugh CW, Ratcliffe PJ. Regulation of angiogenesis by hypoxia: role of the HIF system. Nat Med. 2003;9:677–84.

46.Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg. 2007;119:590–8.

47.Prati JL, Kim DH, Matthewson MJ. Application of static fatigue testing to the behavior of absorbable sutures. J Mech Behav Biomed Mater. 2017;74:232–5.

查看原文

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

The application of corticosteroids for pathological scar prevention and treatment: current review and update