title: The pulley suture: A reliable option for closure of selected soft tissue defects under tension- three years experience of a tertiary care hospital.
abstract: OBJECTIVE
  To assess the outcome of closure of soft tissue defects through pulley suture in different clinical situations.
  
  
  METHODS
  The descriptive chart review was conducted at The Indus Hospital, Karachi, and comprised data from May 2008 to November 2011. A detailed questionnaire was developed to address variables of interest. All patients with less than three months of follow-up or inadequate information were excluded. The data was collected through Health Management Information System. Data was entered and analysed by SPSS 16.
  
  
  RESULTS
  There were 259 patients with 289 wounds in the study. The mean age was 29.2±11.9 years. At follow-up of two weeks, there was wound dehiscence in 2.07%, infection in 0.69% and partial flap necrosis in 1.03% patients. At 12 weeks, hypertrophic scar was reported in 2.07% and stretched scar in 0.3% patients. Acute pain was not reported in the first week of surgery. Type of wound was found to have significant association with complications (p value<0.005). Age and gender were not found have any significant association with complications (p value 0.372 and 0.238 respectively). None of the patients reported scar tenderness at 12-week follow-up. Cosmetic outcome was acceptable to all patients.
  
  
  CONCLUSIONS
  Judicious use of pulley suture can lead to primary closure of selected soft tissue defects under moderate tension. The technique, however, needs to be utilised by surgeons experienced in soft tissue reconstruction.
authors.affiliation: Consultant Plastic Surgeon, The Indus Hospital, Karachi, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Saeed
authors.affiliation: Consultant Orthopaedic Surgeon, The Indus Hospital, Karachi, Pakistan.
authors.forename: Syed Kamran
authors.initials: SK
authors.lastname: Ahmed
authors.affiliation: Consultant Orthopaedic Surgeon, The Indus Hospital, Karachi, Pakistan.
authors.forename: Muhammad Amin
authors.initials: MA
authors.lastname: Chinoy
authors.affiliation: Consultant Orthopaedic Surgeon, The Indus Hospital, Karachi, Pakistan.
authors.forename: Mansoor Ali
authors.initials: MA
authors.lastname: Khan
keywords: Pulley suture, Tension sutures, Wound closure.