Actas Dermo-Sifiliográficas (English Edition) Actas Dermo-Sifiliográficas (English Edition)
Actas Dermosifiliogr 2017;108:607-8 - Vol. 108 Num.7 DOI: 10.1016/j.adengl.2017.03.041
Commentaries
Buried Sutures to Facilitate the Closure of Facial Defects
Facilitando el cierre de defectos faciales con puntos enterrados
G. Romero, , P. Cortina
Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

Routinely omitting subcutaneous sutures in facial defects is a common error. Closure by tissue planes facilitates remodeling and eliminates superficial tension, preventing necrosis and infections and producing more cosmetically acceptable scars.

Buried sutures running from side to side can be used, mobilizing and completely approximating the 2 skin margins, or suspension sutures that advance only 1 side, which is fixed to the periosteum.1 A variant of the first option is proposed in this issue of Actas Dermo-Sifiliográficas,2 mobilizing both margins but without approximating them completely, leaving long, tense sutures called guitar-string sutures. The aim is to approximate the margins, transmitting the tension laterally, eliminating tension from the flap, whose blood supply is always more unreliable. This third option increases versatility.

Suspension sutures enable quality to be maximized in facial remodeling, as they eliminate more than tension. The suspension suture (also known as tacking or fixing stitches)3 is a concept imported from oculoplastic surgery4 and is crucial for obtaining the best results in oncologic dermatologic surgery. Apart from reducing tension, they enable closure to be fixed in the area of union of different cosmetic units, to create folds or avoid their obliteration, to prevent a tenting effect, and to avoid the distortion of orifices (ecnasion, eclabium, ectropion),1 all of which are key points in achieving optimal results.

In summary, the article by Dr. Querol and Dr. Redondo2 is highly recommendable for its originality and relevance, and these 2 classic articles,1,3 which, as good wine, not only do not deteriorate with time, but improve, should also be on everyone's reading list.

References
1
J.K. Robinson
Suspension sutures in facial reconstruction
Dermatol Surg, 29 (2003),
2
Querol E, Redondo P. Suturas en cuerda de guitarra para facilitar el cierre del colgajo digitiforme en la reconstrucción nasal. Actas Dermosifiliogr. 2017. doi:10.1016/j.ad.2017.02.004.
3
S.J. Salasche,R. Jarchow,B.D. Feldman,M.J. Devine-Rust,J. Adnot
The suspension suture
J Dermatol Surg Oncol, 13 (1987), pp. 973-978
4
F.M. Rafaty,R.L. Goode,W.E. Fee
The brow lift operation
Arch Otolaryngol, 101 (1975), pp. 467-468

Please cite this article as: Romero G, Cortina P. Facilitando el cierre de defectos faciales con puntos enterrados. Actas Dermosifiliogr. 2017;108:607–608.

Corresponding author. (G. Romero Gromeroa@gmail.com)
Copyright © 2017. Elsevier España, S.L.U. and AEDV
Actas Dermosifiliogr 2017;108:607-8 - Vol. 108 Num.7 DOI: 10.1016/j.adengl.2017.03.041