Is frosting effective? The role of retention sutures in posttraumatic orbital reconstruction surgery

Plastic surgeons, otolaryngologists, and maxillofacial surgeons routinely perform periorbital fracture fixation in the setting of acute trauma. One of the most common complications of periorbital surgery continues to be lower-lid retraction. The Frost suture has been widely adopted as one of the methods of reducing the frequency of this complication, although there are no compelling data on its efficacy.

A retrospective chart review was performed on trauma patients who had undergone periorbital fracture fixation by one of three reconstructive surgeons at a single facility. A total of 96 patients met the inclusion criteria and were stratified into two groups: those who had received a Frost suture postoperatively and those who had not. The occurrence of retraction was recorded, and statistical analysis was performed controlling for gender and age.

The incidence of lid retraction in the Frost suture group was 12%, in comparison to 7% in the control group, but this difference was not statistically significant. The Frost suture, when placed, remained for 3.72 days on average. Univariate and multivariate logistic regression showed that the complication rate was not affected by age or gender. Within the Frost suture group, the result was not affected by the number of days the suture was left in place.

The placement of a Frost suture in the setting of periorbital surgery, while often routine, lacks strong empirical evidence. This traditional practice involves consistent and specialized follow-up, impedes adequate clinical evaluation in the immediate postoperative period, and leads to considerable patient discomfort without proven therapeutic gain.