This report describes a rare severe tissue reaction, as demonstrated in clinical photographs, to nylon sutures and illustrates how simple immediate removal of sutures isolates the irritant stimulus and results in rapid resolution, without the risk, cost and inconvenience of antibiotic treatment. INTRODUCTION Ethilon Nylon suture is a non-absorbable, monoﬁlament, syn- thetic suture that is commonly used for cutaneous wound clos- ure. It is popular among surgeons because of its high tensile strength, low tissue reactivity and good elasticity [1, 2]. To date, there has been no adverse tissue reaction reported. CASE REPORT A 57-year-old man presented to our plastic surgery service with a clinically suspicious basal cell carcinoma to his left forehead. He was otherwise healthy with no known medical history or any drug allergy. An excision with immediate H-ﬂap recon- struction was performed under local anaesthesia. Wound clos- ure included 5/0 Poliglecaprone 25 (Monocryl) to dermis and 5/0 Nylon (Ethilon) to skin. Surgery was uneventful and the patient returned for routine follow-up 1 week after. At 1 week post- Figure 1: At 1 week post-surgery, the patient appeared to have developed an adverse tissue reaction with intense localized erythema surrounding each surgery, the patient appeared to have developed an adverse tis- Nylon suture tract. sue reaction with intense localized erythema surrounding each Nylon suture track (Fig. 1). Despite this, the patient was asymp- tomatic with no other indicators of infection present. removal, the wound had healed very well and the inﬂamma- Immediate suture removal was performed and a further 1 week tory tissue reaction to Nylon had settled considerably without follow up review was arranged. One week following suture further intervention (Fig. 2). Received: February 5, 2018. Accepted: February 21, 2018 Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2018. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact email@example.com Downloaded from https://academic.oup.com/jscr/article-abstract/2018/3/rjy037/4924897 by Ed 'DeepDyve' Gillespie user on 16 March 2018 2 C. Yip et al. immediate removal of sutures isolates the irritant stimulus and results in rapid resolution, without the risk, cost and incon- venience of antibiotic treatment. CONFLICT OF INTEREST STATEMENT None. FUNDING None. ETHICAL APPROVAL Not applicable. INFORMED CONSENT Figure 2: At 1 week after Nylon sutures removal, the tissue reaction had settled considerably without further intervention. Obtained. Patient has given a written consent for photographs to be taken and be used for publications. DISCUSSION REFERENCES Nylon sutures are used extensively across all surgical special- ties. A search of the literature revealed no reports of adverse 1. Yag-Howard C. Sutures, needles, and tissue adhesives: a cutaneous reaction to nylon sutures, although it is possible review for dermatologic surgery. Dermatol Surg 2014;40:S3–15. that it is more commonly misdiagnosed and treated as infec- 2. Regula CG, Yag-Howard C. Suture products and techni- tion. A number of cases of reaction to nylon sutures were docu- ques: whatto use,where,and why. Dermatol Surg 2015;41: mented in the early 1990s in ophthalmic surgery [3, 4], raising S187–200. the possibility that eye tissue may be more susceptible to this 3. Schechter RJ. Nylon suture toxicity after vitrectomy surgery. type of inﬂammatory response. Ann Ophthalmol 1990;22:352–3. This patient was affected with a rare severe inﬂammatory 4. Balveat HD, Davis RM, Rowsey JJ.. Suture toxicity after cata- reaction to nylon sutures. This case illustrates how simple ract surgery. Ophthalmology 1988;95:1509–14. Downloaded from https://academic.oup.com/jscr/article-abstract/2018/3/rjy037/4924897 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Journal of Surgical Case Reports – Oxford University Press
Published: Mar 1, 2018
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