Summary
Introduction
Technique
Our suturing technique is performed during the second intervention, i.e. bar removal surgery. In this technique, firstly we excise the scar elliptically, which is formed in the former pectus repair surgery (Figure 1), then remove the bar (Figure 2). After that, we approximate the subcutaneous tissue with 3/0 polyglecaprone sutures in order to reduce dermal tension (Figure 2b) and close the skin with 3/0 polyproplene suture subcutaneously (Fig 2c). Two weeks after the surgery we remove the sutures and start the silicone gel therapy. This scar is considered as the last scar which will not be incised again. Not incising over it but excising the old scar, provides us a more controllable new scar with suture techniques and gels.
){kind=link}
){kind=link}
 Click Here to Zoom |
Figure 1: The scar formation due to the first surgery (a). The eliptically incison around the scar tissue (b). |
 Click Here to Zoom |
Figure 2: The skin is excised and the bar is removed (a), the subcutaneous tissue is sutured in order to reduce dermal tension with 3/0 polyglecaprone (b) finally the skin is sutured with 3/0 polypropylene subcutaneously (c). |
Discussion
Immature scars tend to give poor results after scar revision [4]. We remove the pectus bar at least 3 years after the first surgery. This time is sufficient for scar maturation. The second surgery gives us enough time to evaluate the scar and the skin quality of the patients. If there is a tendency for a hypertrophic scar or keloid, we could evaluate this condition during the second surgery and after the scar revision, patient will receive an additional medication such as silicone sheets and/or triamcinolone.
Fonkalsrud et al. detected hypertrophic scars in their series and they recommended to use triamcinolone routinely [5,6]. We expanded and developed Fonkalsrud"s technique and added a scar revision and silicone gel application.
Concerning the length of incision during minimal invasive repair of pectus deformities, they are much more favorable than an open surgery. We think that the incision should also be satisfactory after such a minimally invasive procedure, performed for cosmetic reasons. So we recommend this simple but satisfactory scar revision and suturing technique for bar removal surgeries in chest wall deformities.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Funding
The authors received no financial support.