02. Revision of scars on the thigh without a blunt dissection using an elastic suture with a two-tipped atraumatic needle
KEYWORDS: scar revision, elastic suture, atraumatic two tipped needle.
The excision of large scarred skin areas often involves enlarging the scar due of the increased tension that is created on the edges of the wound.
To get round this problem we have used the new elastic suture (Elasticum®) which has a two tipped Jano needle® (Korpo srl Genoa Italy). This new suture allows us remove the tension in the areas around the wound to therefore obtain a better quality of scar.
Scar de-epithelialisation is performed without skin undermining, hence vascular, nerve and cicatricial damage is avoided. One tip of the Jano needle is inserted into the edge of the cut. The tip comes out at 3 or 4 cm from the wound. By extracting half of the needle the elastic thread is pulled out. The two-tipped needle is not completely extracted. The deep indentations signal the position of the posterior tip which remains inside the subcutaneous tissue.
The posterior tip now becomes frontal, the needle goes back in and then completely comes out of the wound, parallel to the point where it entered.
The two-tipped needle goes back into the edges of the contra lateral wound. The thread is once again pulled through. The operator pulls the needle out as far as the depth required. The thread, which is following the two tips of the needle, is located about 3 or 4 centimetres from the edges of the wound. The needle comes out by the edges of the wound, parallel to the point where it entered. The thread is tied in a knot. The elastic traction is nowhere near the edges. The elasticity of the suture guarantees continued traction over time. In practice, it is as if two fingers were constantly being kept close to the edge of the wound.
Elasticum® was invented to carry out suspension and traction without cutting the tissue. Its consistency is similar to subcutaneous tissue.
1) Il Jano needle is inserted into the edge of the wound.
2) The tip emerges at a distance from the edge.
3) The needle is not extracted completely; the elastic thread is pulled through.
4) The needle re-emerges inside the wound, beside the entry point.
5) The needle is inserted into the contralateral edge.
6) The tip emerges at the same distance from the edge as before.
7) The needle is not extracted completely; the elastic thread is pulled through.
8) The needle re-emerges inside the wound, beside the entry point. The suture is perfectly symmetrical.
9) The elastic thread is placed under traction.
10) The thread is knotted. The edges of the wound can now be stitched without tension.
Revision of a scar on the arm with Elasticum® thread mounted on a two-tipped atraumatic needle
The polyester coating, colonised by the fiber-histiocytic cells, stabilises the traction during time and the elastic thread is integrated into the tissues The edges of the wound, which are no longer under tension, can be sutured with an intradermal thread. A few matching points complete the suture
From 2004 to 2007, at S. Martino Hospital in Genoa, 125 scar excisions were performed; Elasticum® EP 4 threads were used for scars on the body and Elasticum® EP 3.5 threads were used for facial scars. No complications occurred.
Capurro S, Rosanna D.C., Gabrielli A, Capurro M.E., Serra Cervetti G.G. (2007): Revision of scars on the thigh without a blunt dissection using an elastic suture with a two-tipped atraumatic needle. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org
Can the elastic thread and two-tipped needle be used for revision of all large skin scars?
Yes. The elastic thread and two-tipped needle are particularly useful for suturing wounds under tension, for example in round block of the areola or short-scar elastic arm-lifting, in order to draw together the edges of wounds in patients who are intolerant of re-absorbable dermal and subcutaneous sutures.
It seems like an easy technique?
It is easy, though it does require precision. It is essential to realise that the anterior tip of the Jano needle® becomes posterior and the posterior tip becomes anterior whenever the needle changes direction. The fact that the elastic thread is anchored a few centimetres away from the wound means that the edges of the wound can subsequently be stitched without being under tension.
The technique of the revision of large scars by means of the elastic thread and the two-tipped atraumatic needle – video publication (2) – has often been used successfully. We no longer need to be afraid that unsightly scars may be left behind after ample skin excision to remove neoformations, tattoos and scars caused by injuries or burns. (30/07/15)