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In addition to the article attached by Dr. Tejana, we published an article on the use of fast absorbing gut on the face.


If you pull the actual article: we asked the families to keep a suture log describing the time frame of self dissolving for "fast absorbing" and many had sutures still in place after 7 days; some even took 14 days to fully dissolve. This is why I now instruct families to gentle rub the sutures out if still visible at 7 days.


Bob Flood,

Saint Louis University


Pediatr Emerg Care.<https://www.ncbi.nlm.nih.gov/pubmed/23714755#> 2013 Jun;29(6):691-5. doi: 10.1097/PEC.0b013e3182948f26.
Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations.
Luck R<https://www.ncbi.nlm.nih.gov/pubmed/?term=Luck%20R%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>1, Tredway T<https://www.ncbi.nlm.nih.gov/pubmed/?term=Tredway%20T%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>, Gerard J<https://www.ncbi.nlm.nih.gov/pubmed/?term=Gerard%20J%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>, Eyal D<https://www.ncbi.nlm.nih.gov/pubmed/?term=Eyal%20D%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>, Krug L<https://www.ncbi.nlm.nih.gov/pubmed/?term=Krug%20L%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>, Flood R<https://www.ncbi.nlm.nih.gov/pubmed/?term=Flood%20R%5BAuthor%5D&cauthor=true&cauthor_uid=23714755>.
Author information<https://www.ncbi.nlm.nih.gov/pubmed/23714755#>
Abstract
OBJECTIVE:

We sought to compare cosmetic outcomes, complication rates, and patient/caregiver satisfaction of absorbable versus nonabsorbable sutures in children.

METHODS:

Healthy patients, 1 to 18 years old, with facial lacerations 1 to 5 cm, were randomized to repair with fast-absorbing catgut (FAC) or nylon (NYL) sutures. Patients returned in 4 to 7 days and in 3 to 4 months, at which time photographs and caregiver surveys were completed. Unlike part I, all FAC sutures were permitted to absorb rather than be removed. Using a 100-mm visual analog scale (VAS), a noninferiority (NI) design was applied, with a difference of less than 15 mm considered clinically equivalent. Caregivers and 3 blinded physicians independently rated the scars via photographs.

RESULTS:

Ninety-eight patients were enrolled, 76 caregiver surveys were completed, and 61 (29 FAC, 32 NYL) had photographs scored by physicians. The mean physician VAS scores for FAC and NYL were 57.6 and 67.6, respectively (difference, -10.0; 95% confidence interval, -19.1 to -0.4); thus, NI could not be established. The mean caregiver VAS scores for the FAC and NYL groups were 93.8 and 86.6, respectively (difference, 7.2; 95% confidence interval, -4.9 to 13.9); thus, NI of FAC was established. There were no significant differences in rates of infection, wound dehiscence, or keloid formation. In terms of future preference, caregivers favored FAC (33/33) over NYL (26/36) (P < 0.01).

CONCLUSIONS:

Caregiver VAS scores showed NI of FAC, which were also preferred by the caregivers. However, NI for FAC could not be demonstrated by blinded physicians with respect to cosmetic outcomes.

________________________________
From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Cena Tejani <[log in to unmask]>
Sent: Tuesday, August 22, 2017 9:48:53 AM
To: [log in to unmask]
Subject: Re: Facial sutures?

The reason not to use vicryl rapide on the face is that it takes much
longer to fully absorb.  It works very well on the trunk and extremities,
but potential for worse scars on the face exists.  See article for details.
Cena Tejani

On Tue, Aug 22, 2017 at 9:39 AM, Mike Falk <[log in to unmask]> wrote:

> I always use "fast gut" when closing facial lacerations, but if it's not
> available, what would you use?  Anyone know of any reason to not use vicryl
> rapide?
> Thanks,
> Mike Falk
> NY, NY
>
> Sent from my iPhone
> 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
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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:
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