J Oral
MaxillofacSurg
50:1024-1025, 1992
USE OF ABSORBABLE SUTURES FOR FACIAL SKIN WOUNDS
REDUCING OPERATING TIME WITH USE OF A BONE PLATE FOR ADVANCEMENT GENIOPLASTY
To the Editor:-1 recently have had excellent results closing a series of facial skin wounds with absorbable sutures. The wounds were indistinguishable from wounds closed with nonabsorbable (nylon) sutures and use of the sutures has the many potential advantages that come with a technique that does not require suture removal in the early postoperative period. Although by no means an innovation on my part,‘,’ I am not aware of reports describing use of this technique in the oral and maxillofacial surgery literature. I am hopeful that by sharing this concept with members of our specialty that a greater number of surgeons may judge for themselves the value such an approach may have for their patients. I have used rapidly absorbable 6-O plain gut sutures for closure of preauricular incisions for temporomandibular joint surgery, eyelid incisions for orbital trauma surgery, and submandibular incisions. For iliac crest doncr site incisions, 1 have used 4-O plain gut sutures. Patients are allowed to shower 2 days after surgery with no particular efforts made to cover the wounds after the initial 1 or 2 days of coverage with surgical tape. A long-lasting suture, such as Vicryl (Ethicon, Johnson & Johnson, Somerville, NJ), is used for dermal closure. The premise behind the use of absorbable suture is that dissolution of the material occurs so rapidly that there is no time for unfavorable inflammation or epithelial migration along the suture tracts. At 1 week postoperatively there seems to be typically slightly greater erythema than with nylon sutures, but by the second and third weeks there is no appreciable difference. The resorbable sutures usually are unraveling by 6 to 7 days. There are obvious advantages to the use of absorbable sutures if, indeed, there proves to be no demonstrable differences in the quality of wound healing. These are avoidance of the discomfort to the patient incurred by the sutureremoval process and elimination of surgical staff time and use of instrumentation for suture removal.
To the Editor:-1 read with interest the article by DeFreitas et al regarding “A Retrospective Study of Advancement Genioplasty Using a Special Bone Plate” (J Oral Maxillofac Surg 50:340, 1992). The discussion by Dr Precious that followed was also of considerable value. I must, however, disagree in one respect with Dr Precious regarding the use of the most inexpensive type of fixation. One aspect that was not considered was the additional length of time involved as well as the manipulation of the inferior genial segment when passing multiple intraosseous wires. I have found in my own experience that the use of the chin plate is very simple and rapid and, as a consequence, it decreases the amount of operating room time necessary to complete the procedure. When this is considered, the expense of the plate versus the savings in operating room time minimizes the actual expense involved. STEVEN M. SULLIVAN, DDS
Oklahoma City, Oklahoma
YOU’RE IN GOOD HANDS WITH AAOMS
MUTUAL
To the Editor:-1 am writing to express pride and gratitude to “our” insurance carrier AAOMS Mutual. I recently went through the excruciating experience of being falsely accused of malpractice. AAOMS Mutual provided the kind of support that I don’t believe could be offered by any other carrier, because they understood the many dimensions of the case. They stood firm and were supportive all the way through the ordeal. We really are in “good hands” when we have our colleagues’ hands supporting us. I am very grateful. MORRIS S. CLARK, DDS
Denver, Colorado
THE NEED FOR STANDARDIZED PHOTOGRAPHS To the Editor:-The use of photographs to illustrate articles describing surgical techniques for correction of facial esthetic problems has become standardiied in the surgical literature. Proper evaluation of a surgeon’s techniques requires preoperative and postoperative views of the patient using a similar pose, distance from camera, and lighting. The recent article “Calibrated Weir Procedure for Treatment of the Flared Alar Base: Report of Case” by Drs Rider, Leban, and Williams (J Oral Maxillofac Surg 50~518, 1992) violates this requirement. In Figure 2, a preoperative photo illustrates the patient’s appearance following orthognathic surgery, showing alar flaring. In this photograph the patient is smiling and there is an artificially widened alar base. Figure 4 shows the patient 2 weeks after an alar reduction procedure and the patient is in a natural pose without smile. It is impossible to get an appreciation of what change might have occurred in the alar base from these two photographs. In fact, one might draw the conclusion that very little or no change has been made. When authors submit photographs to illustrate their manuscripts submitted for publication in the Journal it
ROBERT CHUONG, MD, DMD St Petersburg, Florida
References 1. Webster RC, Davidson TM, Smith RC: Wound closure with absorbable sutures. Laryngoscope 86: 1280, 1976 2. Webster RC, McCullough EG, Giandello PR, et al: Skin wound approximation with new absorbable suture material. Arch Otolatyngol I 11517, 1985 Letters to the Editor are considered for publication (subject to editing and abridgment), provided that they are submitted in duplicate. signed by all authors, typewritten in double spacing. and do not exceed 40 typewritten lines of manuscript text (excluding references). Letters should not duplicate similar material being submitted or published elsewhere. Letters to a recent Joztra/ article must be received within 6 weeks of the article’s publication. Receipt ofIettersis not acknowledged: correspondents will be notified when a decision is made.
1024
LETTERS
1025
TO THE EDITOR
should be an absolute requirement that these photographs conform to standards of patient positioning, distance, lighting, and type of facial pose so that readers can gain an objective awareness of what has been accomplished by the surgical procedure. If such photographs are not provided
by the author or are not available, the article should not be accepted for publication. ROGER A. MEYER, MD, DDS, FACS Marietta, Georgia
1 -lCHlLDREN 2101 Wllson Bhfd Suite 550 Arlington, VA 22XJl mJ3) 23!i-3gw TDD: 1-800-826-7653 l
:
l
MICHAEL MAYFIELD Abducted by an unknown individual Date Missing: 01/10/85 Missing From: Houston, Texas Date of Birth: 06/06/78 Age at Disappearance:6 years Sex: Male Race: Black Heighti 3 ft 0 in Weight: 75 lb Hair: Black Eyes: Brown Additional IdentlQing Information: None. Circumstances: Michael was last seen walking home from school with his sister, Pamela. ANYONE HAVING INFORMATION SHOULD CONTACT The National Center for Missing and Exploited Cblldren 1-880-843-5678 OR Houston Police Department 1-713-222-3881
MaxillofacSurg
50:1024-1025, 1992
USE OF ABSORBABLE SUTURES FOR FACIAL SKIN WOUNDS
REDUCING OPERATING TIME WITH USE OF A BONE PLATE FOR ADVANCEMENT GENIOPLASTY
To the Editor:-1 recently have had excellent results closing a series of facial skin wounds with absorbable sutures. The wounds were indistinguishable from wounds closed with nonabsorbable (nylon) sutures and use of the sutures has the many potential advantages that come with a technique that does not require suture removal in the early postoperative period. Although by no means an innovation on my part,‘,’ I am not aware of reports describing use of this technique in the oral and maxillofacial surgery literature. I am hopeful that by sharing this concept with members of our specialty that a greater number of surgeons may judge for themselves the value such an approach may have for their patients. I have used rapidly absorbable 6-O plain gut sutures for closure of preauricular incisions for temporomandibular joint surgery, eyelid incisions for orbital trauma surgery, and submandibular incisions. For iliac crest doncr site incisions, 1 have used 4-O plain gut sutures. Patients are allowed to shower 2 days after surgery with no particular efforts made to cover the wounds after the initial 1 or 2 days of coverage with surgical tape. A long-lasting suture, such as Vicryl (Ethicon, Johnson & Johnson, Somerville, NJ), is used for dermal closure. The premise behind the use of absorbable suture is that dissolution of the material occurs so rapidly that there is no time for unfavorable inflammation or epithelial migration along the suture tracts. At 1 week postoperatively there seems to be typically slightly greater erythema than with nylon sutures, but by the second and third weeks there is no appreciable difference. The resorbable sutures usually are unraveling by 6 to 7 days. There are obvious advantages to the use of absorbable sutures if, indeed, there proves to be no demonstrable differences in the quality of wound healing. These are avoidance of the discomfort to the patient incurred by the sutureremoval process and elimination of surgical staff time and use of instrumentation for suture removal.
To the Editor:-1 read with interest the article by DeFreitas et al regarding “A Retrospective Study of Advancement Genioplasty Using a Special Bone Plate” (J Oral Maxillofac Surg 50:340, 1992). The discussion by Dr Precious that followed was also of considerable value. I must, however, disagree in one respect with Dr Precious regarding the use of the most inexpensive type of fixation. One aspect that was not considered was the additional length of time involved as well as the manipulation of the inferior genial segment when passing multiple intraosseous wires. I have found in my own experience that the use of the chin plate is very simple and rapid and, as a consequence, it decreases the amount of operating room time necessary to complete the procedure. When this is considered, the expense of the plate versus the savings in operating room time minimizes the actual expense involved. STEVEN M. SULLIVAN, DDS
Oklahoma City, Oklahoma
YOU’RE IN GOOD HANDS WITH AAOMS
MUTUAL
To the Editor:-1 am writing to express pride and gratitude to “our” insurance carrier AAOMS Mutual. I recently went through the excruciating experience of being falsely accused of malpractice. AAOMS Mutual provided the kind of support that I don’t believe could be offered by any other carrier, because they understood the many dimensions of the case. They stood firm and were supportive all the way through the ordeal. We really are in “good hands” when we have our colleagues’ hands supporting us. I am very grateful. MORRIS S. CLARK, DDS
Denver, Colorado
THE NEED FOR STANDARDIZED PHOTOGRAPHS To the Editor:-The use of photographs to illustrate articles describing surgical techniques for correction of facial esthetic problems has become standardiied in the surgical literature. Proper evaluation of a surgeon’s techniques requires preoperative and postoperative views of the patient using a similar pose, distance from camera, and lighting. The recent article “Calibrated Weir Procedure for Treatment of the Flared Alar Base: Report of Case” by Drs Rider, Leban, and Williams (J Oral Maxillofac Surg 50~518, 1992) violates this requirement. In Figure 2, a preoperative photo illustrates the patient’s appearance following orthognathic surgery, showing alar flaring. In this photograph the patient is smiling and there is an artificially widened alar base. Figure 4 shows the patient 2 weeks after an alar reduction procedure and the patient is in a natural pose without smile. It is impossible to get an appreciation of what change might have occurred in the alar base from these two photographs. In fact, one might draw the conclusion that very little or no change has been made. When authors submit photographs to illustrate their manuscripts submitted for publication in the Journal it
ROBERT CHUONG, MD, DMD St Petersburg, Florida
References 1. Webster RC, Davidson TM, Smith RC: Wound closure with absorbable sutures. Laryngoscope 86: 1280, 1976 2. Webster RC, McCullough EG, Giandello PR, et al: Skin wound approximation with new absorbable suture material. Arch Otolatyngol I 11517, 1985 Letters to the Editor are considered for publication (subject to editing and abridgment), provided that they are submitted in duplicate. signed by all authors, typewritten in double spacing. and do not exceed 40 typewritten lines of manuscript text (excluding references). Letters should not duplicate similar material being submitted or published elsewhere. Letters to a recent Joztra/ article must be received within 6 weeks of the article’s publication. Receipt ofIettersis not acknowledged: correspondents will be notified when a decision is made.
1024
LETTERS
1025
TO THE EDITOR
should be an absolute requirement that these photographs conform to standards of patient positioning, distance, lighting, and type of facial pose so that readers can gain an objective awareness of what has been accomplished by the surgical procedure. If such photographs are not provided
by the author or are not available, the article should not be accepted for publication. ROGER A. MEYER, MD, DDS, FACS Marietta, Georgia
1 -lCHlLDREN 2101 Wllson Bhfd Suite 550 Arlington, VA 22XJl mJ3) 23!i-3gw TDD: 1-800-826-7653 l
:
l
MICHAEL MAYFIELD Abducted by an unknown individual Date Missing: 01/10/85 Missing From: Houston, Texas Date of Birth: 06/06/78 Age at Disappearance:6 years Sex: Male Race: Black Heighti 3 ft 0 in Weight: 75 lb Hair: Black Eyes: Brown Additional IdentlQing Information: None. Circumstances: Michael was last seen walking home from school with his sister, Pamela. ANYONE HAVING INFORMATION SHOULD CONTACT The National Center for Missing and Exploited Cblldren 1-880-843-5678 OR Houston Police Department 1-713-222-3881
