I will be doing an otoplasty surgery next month. I asked the doctor if I need to return back after 7 days to remove the sutures and he said no. He said, he'll be using non absorbable sutures on the inside and absorbable sutures on the outside, therefore I do not need to stitch off. However, I learnt that non absorbable sutures HAVE to be removed so it doesnt really make sense for him to use it on the inside right? I am really worried now and wonder if I should do this surgery with him.
Is it OK for Non Absorbable Sutures to be Used on the Inside of Ear?
Doctor Answers (9)
Otoplasty Uses Internal Non-Absorbable Sutures For Cartilage Shaping
Your perceptions about sutures and how they are used in otoplasty surgery is not accurate. Your plastic surgeon and the suture methods that are being proposed are precisely how most otoplasties are done. It is common practice to use permanent/non-absorbable sutures for the cartilage manipulation on the inside and dissolveable sutures for the skin closure on the outside. There are good reasons for why this is done that way. For the first few months after surgery, it is the internal sutures that are holding the ear's shape. Eventually scar tissue will assume that role but not early on. Dissolveable sutures may get weak and break before sufficient scar tissue has formed, thus causing the ear to change shape or partially pop back out. Non-absorbable sutures offer the best shape-holding capability as they don't weaken or break down during the healing process. And no you don't have to go back in to remove the sutures one day. They will remain inside forever and only occasionally pose a reaction problem where one may have to be removed as it comes through the skin.
Sutures in otoplasty
There are a couple of layers of importance in Otoplasty. The structure of the ear is help in place by internal sutures. Most commonly, these are non-absorbable (ie permanent) sutures. They remain in the cartilage, under the skin and do not need to be removed. The skin is another layer. This can be closed with either absorbable or non-absorbable suture. The non-absorbable skin sutures do need to be removed from the skin.
In short, his suture selection seems fine, but you do need follow up with him. If he has no scheduled follow up, you need another surgeon.
Otoplasty often is performed with suture techniques. A common suture use for the reshaping of the ear cartilage is called mersilene which is a non absorbable braided suture. This suture is not removed unless it extrudes an uncommnon but recognized complication of otoplasty. The skin sutures may be absorbable which dissolve. Surgeons may use absorbable sutures on the skin to avoid the need to remove them.
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Sutures used in otoplasty
During the otoplasty procedure it is common to use permanent sutures to hold the ear cartilage into its new anatomical position. The antihelical fold is being recreated to hold the ear back and this is done with permanent sutures. The sutures used to close the skin incision are usually dissolvable stitches.
Your surgeon has described the use of absorbable and non-absorbable sutures correctly. Permanent (non-absorbable) sutures are commonly used to do the internal work in otoplasty surgery. The final layer closure of skin may be done with either type of suture.
Suturing for Otoplasty
To perform an otoplasty, one usually uses absorble as well as non-absorbable sutures. I use non-absorbable sutures to secure the cartilage----I want lasting strength here. I use abosrbable sutures on the deep skin closure. I expect that the healing skin will "dissolve" this suture within 8 weeks. I use non-abosrbable sutures on the shallow skin because I take those out in 7-10 days. Diffferent sutures are made of different materials. Different sutures do different jobs. Choosing the correct suture for the right job is important to getting a good result.
Cartilage reshaping with sutures requires the use of non-absorbable sutures or at least those that last a very long time. These sutures stay in place and your body will usually have no problem with them. The sutures on the skin, however, should be removed within seven days in order to prevent the formation of visible scars. Your surgeon may be using a rapidly dissolving suture, which does not necessarily have to be removed.
At any rate, your surgeon has described the procedure as it is correctly performed. You should not worry about the sutures!
Choice of suture in otoplasty
What you are describing is how the Otoplasty operation is done. The surgeon will use non absorbable sutures on the cartilage. the cartilage had memory and wants to bend out. Use of absorbable sutures would not hold the cartilage long enough. We use non absorbable sutures often in surgery, (e.g.; abdominal wall closure, etc:). They do not have to be removed.
The absorbable sutures on the skin are often used to alleviate discomfort of taking them out. This is also appropriate and we do this often on plastic surgery, (e.g. taking nylon sutures out of the hand of a three year old is not fun for anyone.)
Best to get a few consults with a board certified Plastic Surgeon or Otolaryngologist, (ENT). Together you will come up with an appropriate plan.