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In all studies that I am aware of, no statistical difference found between absorbable vs nonabsorbable sutures in terms of esthetic outcome (Pediatric Emergency Care  Volume 23, Number 5, May 2007). That includes studies where gut was used in the face (Pediatr Emer Care 2013;29: 691-695; Am J Emerg Med. 2004;22:254–257). Plain gut fast absorbing is the first choice of our plastic surgery chief for facial laceration, when glue is not an option. (http://www.urgencehsj.ca/protocoles/laceration/).
We use nonabsorbable only when a lot of tension.

I routinely put steri-strip after plain gut fast absorbing in the face. The idea being that I want to reduce wound tension, which in theory can help esthetic outcome. I ask parents to put new steristrip back in the first 2 weeks if some falls off. The Roberts and Hedges clinical procedures textbook says (page 636) we could do it for as long as 5 weeks given that wound contraction and scar widening continue for 42 days.
The only study that looked at the question, that I am aware of, didn't find any benefit though (JAMA Dermatol 2015;151(8):862-867<http://mailer.cma.ca/t/4881456/241678/41663614/0/>). But the sutures were done after a surgical excision procedure and were buried interrupted subcuticular sutures on adult patients, about half in the face. Not necessarly applicable to our population.


Matthieu



Matthieu Vincent

MD, FRCPC

Emergency medicine and Pediatric emergency medicine specialist

Emergency departement, CHU St-Justine, Quebec, Canada

Adjunct professor in the department of Paediatrics, Faculty of Medicine, McGill University

Emergency departement, Charles Lemoyne hospital, Quebec, Canada

Clinical assistant professor, Faculty of Medicine, Sherbrooke University


________________________________
De : Pediatric Emergency Medicine Discussion List <[log in to unmask]> de la part de trzim29 <[log in to unmask]>
Envoyé : 20 mai 2017 10:40
À : [log in to unmask]
Objet : Re: Wound Adhesive over FA Gut Suture

I put a steri strip on top. Don't know if it does anything.Have had good feedback from families.Just a side note, as noted, are you using 5-0 on faces?Also, not sure if I am remembering this correctly...gut on the face may cause an ever so slightly increase in scarring but not enough to not use it as you don't have to take them out...Maybe I dreamt that?Go Knicks #TrueFanPeace out Pediatrons.Todd Z
PS Had n 8 month old bronchiolitic 2 days ago, not in distress but sounded like crap.
Completely cleared after 2 DuoNebs.Grandpa had asthma.Just sayin'.


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-------- Original message --------From: Amy Johnson <[log in to unmask]> Date: 5/19/17  9:03 PM  (GMT-06:00) To: [log in to unmask] Subject: Re: Wound Adhesive over FA Gut Suture
What a great idea!

I use fast absorbing gut sutures a lot. I have gotten patient feedback, however,  that some of the sutures come apart in a few days rather than preferred 7 day time period. As such, I have started putting more knots in absorbable sutures. I usually use 5.0 rather than 6.0 because the 6.0 is so fragile.

I am interested in getting others feedback on this issue.

Warm Regards,
Amy E. Johnson, M.D.
Carepoint PC
Rocky Mountain Hospital for Children
Denver, CO

> On May 19, 2017, at 12:00 PM, Richard Bruckner <[log in to unmask]> wrote:
>
> Wondering if anyone has any literature to support or oppose the use of wound adhesive as a "sterile dressing" on top of simple interrupted fast absorbing gut sutures?
> Anecdotally I have used it to "support" the relatively fragile 6/0 FA gut sutures with success.
>
> Rich Bruckner
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html