[Clinical effect of Zhang's super tension-relieving suture for high-tension wound closure]

Objective: To investigate the clinical effect of Zhang's super tension-relieving suture applied in high-tension wound closure. Methods: From January to August 2019, 19 eligible patients with scar or black hairy nevus were treated with Zhang's super tension-relieving suture for outpatient operation in the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were composed of 6 males and 13 females, aged 10-68 years, with 8 keloids, 3 hypertrophic scars, 5 atrophic scars, and 3 black hairy nevus. The operation sites included lower jaw in 2 cases, neck in 3 cases, chest in 4 cases, abdomen in 2 cases, and limbs in 8 cases. The size of scars and black hairy nevus before surgery ranged from 1.4 cm×1.1 cm to 10.0 cm×4.0 cm. All the lesions underwent excision alone with both sides of the incision undermined for 1 to 2 cm, and the wound size ranged from 2.6 cm×2.6 cm to 12.6 cm×6.8 cm. Zhang's super tension-relieving suture was applied with barbed suture, and the wound edges were naturally jointed with relaxation and low tension by pushing normal skin on both sides to the middle. Two patients with keloids underwent superficial radiotherapy within 24-hour interval after the surgery, with a total of 20 Gy delivered in 4 times, once a day. All the patients were followed up at outpatient clinics, with tension-relieving duration and adverse effects recorded. Six months after operation, the Vancouver Scar Scale (VSS) was used to evaluate scar appearance, while scar width and recurrence were recorded. Results: All the wounds of 19 patients healed completely after surgeries. Two patients experienced transient hyperpigmentation at puncture points and recovered without intervention, and one of them had hypertrophic scar at the puncture point, which was relieved after intralesional injections of corticosteroids. One patient underwent transient erythema, dry desquamation, and hyperpigmentation after radiotherapy, which recovered without intervention. Follow-up time ranged from 7.1 to 13.6 months, with an average of 9.6 months. Tension-relieving duration ranged from 4 to 26 weeks, with an average of 11.2 weeks. Two patients underwent Zhang's super tension-relieving suture again 8 weeks after operation due to their short tension-relieving duration which lasted for only 4 weeks after the first suture. Six months after operation, liner scars were achieved in all the patients with an average width of 2.2 mm (0.8 to 7.0 mm) and an average VSS score of 2.1 points (1.0 to 4.3 points). Three keloid patients had local recurrence 3 months after surgery for not receiving radiotherapy, which was obviously relieved following laser treatment in combination with intralesional injections of corticosteroids and 5-fluorouracil, etc. Conclusions: Zhang's super tension-relieving suture technique with barbed suture is able to effectively relieve the tension on wound edges, extend the tension-relieving duration, and reduce the hypertrophic scar risk when applied in high-tension wound.