INVITED COMMENTARY 3. Oshumi N (1995) A new skin technique for multiple Z-plasty. References Plast Reconstr Surg 96:1713±1714 4. Saleh M, Howard AC (1994) Improving the appearance of pin- site scars. J Bone Joint Surg [Br] 76:906±908 1. Breuninger H (1997) Navel reconstruction after umbilical mela- 5. Stanec Z, Delimar D, Stanec S (1997) Simple securing of subcu- noma excision. Eur J Plast Surg 20:325±327 ticular running suture. Ann Plast Surg 39:332 Ï 6. Vegter F, Hage JJ (1997) A theoretical consideration of exten- 2. Delimar D, Korzinek K (1996) Secure instrument tie knot. Eur J Surg 162:505±506 sion s of the Z-plasty principle. Eur J Plast Surg 20:71±76 I remember Borges, the great proponent of the W-plasty where there appears to have been severe disturbance of writing that he never regretted having used a W-plasty, wound healing with this material. In two cases, the suture and although I have been, on the whole, happy with the has been extruded through considerable lengths of the technique I am perhaps a little more selective with my ap- scars on both sides resulting in wound breakdown and plication of it. Now that this idea of a subcuticular suture in the third, the scar looked inflamed early in the postop- has delivered us from the tedium of placing a whole lot of erative period and has remained red and thick for six interrupted skin sutures, with all their disadvantages (as months so far. pointed out by the authors), it is possible that W-plasties Coming soon in this journal is a very good compara- will become even more popular. tive study on suture techniques in breast reduction, and Of course, one can always add one or two normal skin the authors describe similar problems with intradermal sutures to adjust any irregularities. The advantages of ab- dissolvable sutures. There is still much to be said for what sorbable subcuticular sutures are described but no men- some would consider old fashion techniques! tion has been made of any tissue irritation with an absorb- able suture in this paper. Of course, this complication is D.E. Tolhurst dependent on the type of materials used. I have been em- 47 Aylesford Street ploying intradermal monocryl in all breast and abdominal London SW1V 3RY UK operations for about 18 months, and have had three cases AUTHOR'S REPLY D. Delimar For adult patients with short wounds, we use nonabsorb- University of Zagreb able Ethilon polyamide Ethicon suture. In patients with Clinical Hospital Center longer wounds and always in children we use absorbable Department of Orthopaedic Surgery Monocryl poliglecaprone 25 Ethicon suture. We did not ƒalata 7 notice any adverse effects with Monocryl sutures. This 1000 Zagreb, Croatia may be due to the fact that suture position does not corre- spond directly with the scar (wound) line like in straight wounds. European Journal of Plastic Surgery Springer Journals


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Copyright © 1999 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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