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Closing incisions is an inherent part of every surgery and a well healed and good looking scar is a desireable goal. But for plastic surgeons the appearance of the incisional closure and the resultant scar takes on even greater significance. For operations that are done for cosmetic change only, a good looking scar is an essential part of how the result will be perceived.

To get the best scar outcomes from incisional closures, plastic surgeons pay great attention to the relief of underlying wound tension and the meticulous approximation of the skin. For these reasons either very small sutures are used in many facial areas and a subcuticular (under the skin) technique is used for large body areas under the skin. While most only see what is placed at the skin level, what is buried underneath the skin in the dermis is of equal importance. This requires the placement of many intradermal buried sutures, usually of a resorbable material.

This intradermal suture placement is essential but tedious and certainly adds to intraoperative time. To simplify this level of suturing, an absorbable stapling device (Insorb) was introduced several years ago. This device places small staples made of resorbable polymers (polylactide-polyglycolide) that have a long history of use as resorbable sutures and plates and screws. The minute staples are placed in a horizontal orientation by a patented stapling device that can deploy up to 30 staples. The staples are placed right under the skin in the thick dermis to approximate the skin. They will resorb completely by a natural hydrolysis process over 6 to 9 months.

The Insorb device is intended to replace the need for external skin staples and/or the need for subcuticular skin sutures. For some body plastic surgery procedures, such as tummy tucks and breast reductions, this device can have a useful role. While not eliminating the need for a subcuticular skin closure, it can alleviate the need for intradermal suturing. In the face, however, the skin is too thin to permit even this very small size of the staple to be useful.

Dr. Barry Eppley

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