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Table 1: Complications in both groups and found no significant difference in the cosmetic
Complications Number of patients outcome and complication rate.
[11]
Group 1 Group 2 Al‑Abdullah et al. performed a systematic review of
Infection 2 2 randomized controlled trials that compared the cosmetic
Wound dehiscence and disruption 0 3 outcomes and complications of traumatic lacerations
Hypertrophic scar 1 1 and found no statistically significant difference between
absorbable and nonabsorbable sutures in short‑term or
long‑term cosmetic score, scar hypertrophy, infection rate,
Table 2: VAS scoring at 1 month wound dehiscence, and wound redness/swelling. This
VAS observer Group 1 Group 2 P value meta‑analysis suggests a lack of large, methodologically
Observer 1 87.1–90.6 88.3–94.0 <0.05 statistically no sound study evaluating the effectiveness of absorbable
(blinded observer) (mean: 90.3) (mean: 91.7) significant difference versus nonabsorbable sutures.
Observer 2 89.1–93.6 88.3–96.0 <0.05 statistically no
(surgeon) (mean: 90.3) (mean: 91.7) significant difference Shinohara et al. [12] used monofilament nylon
Observer 3 78.4–90.1 86.9–93.4 <0.05 statistically no as nonabsorbable material and polyglyconate,
(patients parent) (mean: 84.2) (mean: 90.1) significant difference polydioxanone as absorbable suture material and found
VAS: Visual analog scale no significant difference in the cosmetic appearance
of the scars. These studies support the view that
Table 3: VAS scoring at 6 months absorbable sutures are preferable to nonabsorbable
VAS observer Group 1 Group 2 P value sutures for primary cleft lip repair. [12,13] In addition,
[14]
Observer 1 88.1–94.6 89.3–95.0 <0.05 statistically no Collin et al. published the disadvantages of using
(blinded observer) (mean: 90.3) (mean: 91.7) significant difference nonabsorbable sutures in cleft lip repair. These include a
Observer 2 88.1–94.6 89.3–95.0 <0.05 statistically no need for additional dressing, and return to the hospital
(surgeon) (mean: 90.3) (mean: 91.7) significant difference for removal of the sutures under sedation or GA. All of
Observer 3 76.4–92.1 86.9–95.4 <0.05 statistically no these contribute to distress in the child and potential
(patient’s parent) (mean: 84.2) (mean: 90.1) significant difference disruption of the repair. [14]
VAS: Visual analog scale
This study shows no significant difference between
Table 4: VAS scoring at 1 year absorbable and nonabsorbable suture groups considering
the cosmetic outcome in primary cleft lip repair. It has
VAS observer Group 1 Group 2 P value
been shown that the VAS is a useful way to document
Observer 1 88.1–94.6 89.3–95.0 <0.05 statistically no subjective analysis of cosmetic outcome in this study. As
[5]
(blinded observer) (mean: 93.3) (mean: 92.7) significant difference patients’ assessment of aesthetic outcome is subjective,
Observer 2 88.1–94.6 89.3–95.0 <0.05 statistically no
(surgeon) (mean: 92.3) (mean: 93.7) significant difference the use of VAS in this study was appropriate.
Observer 3 76.4–92.1 86.9–95.4 <0.05 statistically no A motivational factor to use an absorbable suture for
(patients parent) (mean: 90.2) (mean: 93.1) significant difference
cleft lip patients in this study was to avoid exposure to
VAS: Visual analog scale anesthesia for suture removal after 7 days. Furthermore,
this study shows no clinically significant differences
Different techniques are employed based on surgeon’s in cosmetic appearance between absorbable and
expertise and patient’s anatomical variations. These nonabsorbable sutures at 1 month, 6 months, and 1 year.
patients undergo multiple surgical interventions at a very The results of this study are consistent with previously
young age which poses a great challenge for the surgeons. published reports.
An understanding of both the physical properties of the This study demonstrates that there are no long‑term
material and the resulting tissue response to the material is differences in cosmetic outcome and complication rates
important for choosing the suture material for the procedure. between absorbable and nonabsorbable sutures in patients
Sutures that are absorbable may initiate a prominent tissue with primary unilateral cleft lip. All the patients enrolled in
response and result in suboptimal outcomes including a this study were operated by one surgeon using absorbable
persistent scar, tenderness, and suture extrusion. [6] and nonabsorbable sutures and showed equal results. We

To the best of our knowledge, there are very few studies recommend the use of absorbable suture for the closure
reported in the literature that studied the cosmetic of primary cleft lip as this technique saves one additional
outcomes and complications after cleft lip using exposure of the child for the GA for suture removal.
absorbable and nonabsorbable suture materials. Luck et al.
compared the long‑term cosmetic outcomes of absorbable REFERENCES
versus nonabsorbable sutures for facial lacerations in
children and concluded that fast‑absorbing catgut suture 1. Sandberg DJ, Magee WP Jr, Denk MJ. Neonatal cleft lip and cleft palate repair.
is a viable alternative to nonabsorbable suture in the AORN J 2002;75:490‑8.
repair of facial lacerations in children. [7,8] Holger et al. 2. Firth HV, Hurst JA. Clinical approach. In: Genetics. Oxford: Oxford Medical
[9]
and Karounis et al. compared the use of absorbable and 3. Press; 2006. p. 74‑7.
[10]
Marcusson A, Akerlind I, Paulin G. Quality of life in adults with repaired
nonabsorbable suture in traumatic pediatric lacerations complete cleft lip and palate. Cleft Palate Craniofac J 2001;38:379‑85.
56 Plast Aesthet Res || Vol 1 || Issue 2 || Sep 2014