Setback otoplasty - Dissolvable stitches vs. permanent sutures? How to avoid complications and possible relapse?

I do believe that utilizing temporary, long acting sutures could lead to a less than favorable Otoplasty result. The negative of permanent sutures is that they may get infected or they may extrude. Utilizing nylon sutures over 25 years, we have not seen a single infection. Sometimes, as much as 3 to 5% of patients the knot of a suture can pop through the skin behind the ear. In our experience, this has been of minimal inconvenience to our patience since removing the offensive stitch in the office does not cause a reversal of the result. I hope this helps! Sincerely, Dr. Joseph.

A permanent suture used in an otoplasty will forever hold the cartilage in its new position and shape. While there is the possibility that a knot may be exposed and need to be removed in the future, this rarely alters the shape of the ear. Infection is exceptionally rare after an otoplasty as the ear has such an excellent blood supply. Temporary/dissolving sutures, may allow the elastic cartilage to spring back and may result in a revision otoplasty being performed in the future. Best wishes.

When performing an otoplasty, there are two major components: the anti-helix, which is the fold and the fold has to be bent further. I usually use permanent suture for this. The other component is conchal cartilage. This I usually resect and use absorbable sutures. I also use absorbable sutures on the closure. The advantage of the absorbable sutures is they will not be around to cause infection long term. The disadvantage is they lose their holding power.

Best Wishes,

Gary Horndeski, M.D.

Hello, hope you are well. These are good questions, and things that are discussed among surgeons. You will find lots of variation in the suture materials that are used for otoplasty. I tend to use non-absorbable for Mustarde sutures (anti-helical fold shaping), and absorbable for Furnas sutures (conchal setback). Ask your surgeon their reasoning if you have these questions. Presumably their experience and knowledge informs their judgement. The advantage of absorbable sutures is that issues with extrusion can be avoided. Infections are avoided in any case by using sterile anti-septic technique and prophylactic antibiotics at the discretion of your surgeon.
Best,Dr. Tower

There is data that shows a higher chance of relapse with dissolvable sutures. Some surgeons use dissolvable sutures to avoid the small chance of the permanent sutures spitting through the skin. I use mostly permanent sutures in my practice to reduce the chance of the ears popping back out with time.

Your setback otoplasty should have been planned tailored to your situation. The use of dissolving stitches has the reduced risk of stitch exposure and feeling it under the skin in the future. Also the reduced risk of infection. My personal opinion is that these are a very low risk in general. My preference is to use permanent stitches and sometimes heavier thickness ones. Using a small fascial flap to cover the stitches provides thicker tissue over them to reduce the risk of exposure and feeling them. If the procedure is done carefully, kept clean and use of antibiotics, the risk of infection is very low. The choice of creating either, anti-helical folds where lost, set back of the concha of the ear, or both depends on the problem with your ear. Use of mustarde stitches for the anti-helical folds or furnass stitches for the concha is my preference. Using both is not always a necessity as it can 'over correct' the ear and cause 'telephone deformities'. Relapse has a higher risk in thick cartilages or if healing is compromised during recovery. The need for a revision due to relapse is not uncommon. Discuss the choices above with your surgeon.

Assuming no contraindication or patient refusal, I prefer to use Mersilene (non-dissolvable) sutures during otoplasty surgery to minimize the chance of recurrence of the ear. Other techniques such as cartilage scoring, incision, and excision can also be used to minimize the chance of recurrence. No one technique is perfect. Discuss the proposed technique and rationale for this with your surgeon. If you don't feel comfortable, don't move forward. Make sure you and your surgeon are on the same page and have the same goals and plans in mind for the best possible experience.

Typically, antibiotics are given before and after the surgery to decrease the chance of infection. Keeping areas clean, avoiding any trauma which could incite bleeding, and following your surgeon's instructions are further recommendations for a smooth recovery.