title: Rapid Resorbable Sutures Are a Favourable Alternative to Non-resorbable Sutures in Closing Transcolumellar Incision in Rhinoplasty.
abstract: BACKGROUND
  The open approach using inverted-V incisions has gained popularity in both primary and revision rhinoplasty during the last years. The risk of a disturbing columellar scar has been shown to be very low when meticulously closed. However, the suture extractions are usually painful and time consuming.
  
  
  OBJECTIVE
  To investigate if rapid resorbable sutures could replace non-resorbable sutures in nasal transcolumellar incisions. The present study compared (1) patient discomfort, (2) scarring and (3) risk for postoperative infection.
  
  
  METHODS
  A total of 58 consecutive patients subjected to open rhinoplasty by the same surgeon using midcolumellar inverted-V incisions were investigated retrospectively. Forty-one (71 %) were eligible and investigated, of whom 27 (65 %) were of Middle Eastern descent and the rest Caucasians from Northern Europe. The first 21 patients were sutured with non-resorbable suture material polypropylene (PP) (Prolene(®) 5/0; Ethicon Inc.) and the subsequent 20 patients with a rapidly resorbable suture material, the 5/0 irradiated Polygalactic acid (PGA); (Vicryl Rapide(®) 5/0; Ethicon Inc.). Discomfort from the suture extraction of the PP sutures was compared to trimming of the PGA sutures at the skin surface 1 week postoperatively, and visibility of the columellar scars was evaluated by the patients themselves on a self-report questionnaire. This was done prior to the investigation and postoperative photography at the follow-up visit a minimum of 6 months postoperatively. The postoperative photographs were then assessed by 20 rhinoplasty surgeons independently, using the same questionnaire.
  
  
  RESULTS
  Trimming of the PGA sutures caused significantly less discomfort than the extraction of PP sutures (p ≤ 0.01), of which 6 (29 %) found the suture extraction very painful. Overall, 40/41 (98 %) found their scars non-disturbing. Moreover, 17/21 (81 %) of the patients sutured with PP and 18/20 (90 %) of the patients sutured with PGA considered their scars to be invisible or almost invisible. The corresponding assessments from the observers were 16/21 (76 %) and 16/20 (80 %), respectively. No postoperative infection was found in any group.
  
  
  CONCLUSIONS
  Suturing inverted-V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to non-resorbable sutures as evaluated by patients and observers.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Otorhinolaryngology Head & Neck Surgery, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. babak.alinasab@karolinska.se.
authors.forename: Babak
authors.initials: B
authors.lastname: Alinasab
authors.affiliation: Astoria Clinic, Stockholm, Sweden.
authors.forename: Per-Olle
authors.initials: PO
authors.lastname: Haraldsson
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D002398:Catgut; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult
keywords: Absorbable sutures; Columella; Inverted-V incision; Non-absorbable sutures; Open rhinoplasty; Scar visibility; Transcolumellar incision