Otoplasty - Dissolvable Vs Permanent Sutures

A variety of surgical techniques
are utilized to correct prominent ears. 
Many of these techniques utilize structural sutures to maintain the
shape of the newly formed ear.

When structural sutures are
utilized, they must provide stability until the wounds have healed
adequately.  This may take several
months because the ear cartilage has memory and wants to return to its original
position.  For this reason,
recurrence of prominent ears is a major complication of setback otoplasty.

The procedure can be performed with
permanent or absorbable sutures, but because of the potential for recurrence,
we always use non absorbable permanent sutures. 

In my practice, I utilize permanent sutures in order to decrease the chance of recurrence of the prominent ears over time. Even in these cases, the possibility of a suture breaking or tearing is possible, but I think the risk of recurrence due to suture relaxation or failure is lower. Each surgeon will have their own ideas and recommendations regarding techniques. 
The risks of a permanent suture are that it could extrude through the skin at some point, even years down the line. The risks of a dissolvable suture are that it could fail and lead to recurrence of the prominent ears. In my opinion, the risk of failure with dissolvable sutures outweighs the risk of potential suture issues later with permanent sutures, as these issues can be dealt with usually quite easily in the office if they occur.
Best,

Dear Otoplasty patient from Sydney,
One the most common complications associated with Otoplasty in adults is recurrence of the prominent ears. It also depends if any conchal cartilage was reseceted or not. I personally use permanent sutures and remove conchal cartilage for adults to prevent recurrence.
 

I read your concern. I'm sorry your ears reverted to their pre-op state after your otoplasty surgery.

I have been tempted for years to try long lasting (90-120 days) absorbable sutures, like PDS sutures, for my otoplasty patients.

Permanent sutures are associated with extrusion in around 5% of otoplasty surgeries. This is an acceptable complication rate: an extruded suture may present  well over a year after your surgery, and extrusion typically does not compromise your final result. An extruded stitch may be removed in the office with local anesthetic and minimal inconvenience.

You should do well with permanent suture otoplasty surgery. Could you email me the type and gauge suture your surgeon used? 

Good luck with your ears.

Regards from NJ.

Hello, John, the sutures that are used to shape the ear cartilage can be of absorbable or non absorbable material.  I personally use non absorbable because I feel they do hold up better over time.  The disadvantage is the occasional rejection of the suture by the body.  This is rare and easily managed with a simple suture removal.  Make sure you visit with your surgeon and discuss the pro's and cons with in depth.  Hope this was helpful.

 

Dr D.

Generally I think it is a good idea to use permanent suture suture performing  otoplasty surgery.  Otherwise, I think you're risking an increased chance of recurrence of the prominent ears.  The potential downsides of permanent suture ( including palpability, infection, extrusion and potential need for removal) are outweighed by the advantages of a permanent setback of the ears.

Best wishes.

I am sorry you are having trouble with your ears after your surgery.

As the other surgeons have said, I routinely use permanent sutures for otoplasty. I am concerned that dissolvable suture would not hold over time. 

I also usually score the anterior aspect of the cartilage.  this weakens the front side of the cartilage allowing it to curl backwards to a more natural position.  With the use of permanent sutures and anterior scoring, my recurrence rate is low, but not zero.  I also usually instruct on the wearing of a head band for about 4 weeks postop.  I think this also helps prevent recurrence.

I assume your surgeon is not charging you a fee for his services,  but you may get a charge from anesthesia and the OR.

Good Luck!

Total recurrence of your ear deformities, on both sides and in 4 months is not acceptable and may very well be related to the usage of absorbable sutures and even which type was used as some will not last nearly as long as others.

My recommendation is for permanent sutures as other plastic surgeons have stated. This largely precludes the situation that you are dealing with now.

Good luck!

Otoplasty is a procedure to correct deformities of the ear.  Most of the time, otoplasty is done to make the ears less protruding.  The two most common maneuvers for this are Mustarde sutures and conchal setback, and there are several more as well.  The effect of Mustarde sutures are to recreate a fold in the ear that is normally there.  In performing this procedure 2 mistakes are commonly made:  

(1) Ear cartilage has memory--it wants to keep its shape.  In order to make a fold in the cartilage, the cartilage needs to be bent.  To allow the cartilage to bend, the cartilage is "scored," meaning it is weakened with a series of small scrapes.  This takes out some of the memory of the cartilage.  However, if the scoring is too aggressive, the cartilage becomes too weak and will buckle, making an unnatural appearing sharp fold.  For this reason, many surgeons are too conservative with scoring, and the cartilage will bounce back to its original shape with time.

(2) If placed correctly, permanent sutures are perfectly safe.  The typical suture used is a clear, fine, nonabsorbable suture (nylon).  Resorbable sutures are not necessary and do not prevent complications.  Rather, they provide an opportunity for the cartilage to bounce back once the suture has dissolved.

Regarding : "Otoplasty - Dissolvable Vs Permanent Sutures
4 months ago I had a bilateral Otoplasty to correct my prominent ears. My surgeon used the Mustarde technique with dissolvable sutures. My ears initially healed well, but several months on, both ears relapsed to their pre-op state. My surgeon says that as the sutures dissolved, the ears have subsequently relapsed. He has suggested a revision using permanent sutures. There seems to be some debate over the use of permanent vs dissolvable sutures? What are the risks/benefits for each?..."

Although ears share the same common characteristics they are actually different and differ not only from side to side but much more widely between different people. There are several Ear Pinning (Otoplasty) techniques each named after a known ear surgeon who described it (Senstrom, Mustarde, Davis, Furnas) etc. Most of us combine and modify techniques, as needed, for each patient's particular needs.

I prefer using clear permanent stitches. Unless the spring of the cartilage is weakened (with a modified Senstrom for example), using dissolving stitches to shape the cartilage is essentially betting that the scar tissue that forms after surgery is strong enough to splint and resist the cartilage forces which want to assume the former more open less curved shape. I prefer more "insurance". I accept the very low risk of clear nylon sutures of becoming infected or being extruded to 100% certainty that dissolving sutures would be gone and that my ear correction would be solely dependent on surrounding scar tissue. Therefore in MY opinion, mild weakening of the cartilage springiness (?verb) by careful anterior weakening supplemented by a Mustarde technique with permanent stitches has worked very well.

Dr. Peter Aldea