“Promising” and “applicable to many procedures” are how David Hom, MD, FACS, describes the new methods that were taught at a joint Ethicon/University of Cincinnati Medical Center (UC Medical Center) “Soft Tissue Facial Plastic Surgery” course and lab in August 2016. According to Dr. Hom, who served as director of the program, the new methods — knotless anchor sutures and a newer skin closure system — have the potential to be used extensively in the repair of medium to large size trauma and cancer defects. Dr. Hom also predicts that these wound closure methods, which are now being used in orthopedic and obstetric/gynecologic surgeries, will also become more widespread in otolaryngology procedures.
Dr. Hom is professor and director of the division of facial plastic and reconstructive surgery in the department of otolaryngology ‒ head and neck surgery and professor of otolaryngology – head and neck surgery at UC Medical Center. He is also medical director for facial trauma, specializing in facial plastic and reconstructive surgery, including procedures to improve facial paralysis.
Twenty-three UCMC participants (15 otolaryngology residents, two pediatric otolaryngology fellows,
four dermatology, and two oral maxillofacial residents) attended didactic lectures covering new, as well as conventional techniques during the one-day course, after which they applied those lessons using pig flanks. The presentations and surgical sessions were led by Dr. Hom and UC Medical Center colleagues, Ryan Collar, MD, assistant professor of otolaryngology ‒ head and neck surgery, and Yash Patil, MD, associate professor of otolaryngology.
The advantages of Stratafix™, the newer knotless anchor sutures, are that “they don’t need to be removed, and they don’t leave ‘railroad tracks’ on the skin like traditional stitches,” said Dr. Hom. The small anchors located along the suture approximate the wound edges with gentle traction, which can be tightened further by pulling the suture. These sutures offer more consistent tension control and strength than the continuous closure mechanisms found on conventional sutures. The knotless anchor sutures, which are available in a range of lengths, sizes, and needle options, are being used in open, laparoscopic and robotic procedures in the other specialties.
Another incision closure innovation is the Dermabond Prineo System, a mesh netting made of flexible self-adhesive polyester that is placed over the incision and then coated with a 2-octyl cyanoacrylate topical skin adhesive. This system repels water, has antibacterial properties and may reduce the closure time for the final skin layer. Neither the netting nor the skin adhesive requires removal; instead, they fall off the skin in several weeks. According to Dr. Hom, this delivery system may be “helpful to minimize scar widening, especially on areas of skin movement on the face and neck.”
The course was so well-received that Dr. Hom looks forward to offering a second course/lab, with additional soft tissue reconstruction topics, on August 19, 2017, that will be open to midwestern otolary
ngology residents outside Cincinnati.
Ethicon Wound Closure Resource Center. Available at: https://woundclosure.ethicon.com/. Accessed December 22, 2016.
David Hom, MD
Professor and Director of the Division of Facial Plastic and Reconstructive Surgery in the Department of Otolaryngology ‒ Head and Neck surgery, UC Medical Center