Novel Chest Tube Anchoring and Closure Technique with an Aesthetic Scar

Technique: This chest tube anchoring technique differs from other techniques by introducing 2 layered closure to avoid wound healing complications such as hypertrophic or keloid scar and to achieve airtight closure. The first suture to be used is a monofilament synthetic absorbable 4/0 suture – Monocryl (Johnson & Johnson, New Jersey, USA) that is passed as a buried stitch in the dermal layer. The second suture to be used is a monofilament non-absorbable 3/0 suture – Prolene (Johnson & Johnson, New Jersey, USA) that is passed around the chest tube incision in a horizontal mattress manner taking the muscle/fascia and skin layers. The chest tube is then anchored with a 2/0 silk suture with a mesentery. The three suture ends are secured and wrapped around the chest tube with Steri-Strips™ (3M™, Minnesota, USA). Two long dressings are sandwiched together, partially on skin and partially on the tube as dressing anchors. Results: This technique has shown good results with no complications. Routine chest radiograph and physical examination showed no signs of pneumothorax or discharge from the wound nor any wound healing complications. Conclusion: This chest tube anchoring and closure technique is secure and produces an aesthetic pleasing scar that does not require any expensive sutures or special skills.

A novel subdermal anchoring technique for the effective treatment of congenital melanocytic nevus using de-epithelialized dermal flaps

Background In patients with congenital melanocytic nevus (CMN), single-stage removal of large lesions can be difficult because the high tension created by excising and repairing a large lesion may result in scar widening. Herein, we introduce a method to effectively excise lesions while minimizing scarring and compare its outcomes to those of existing surgical methods.Methods We compared patients who underwent surgery using the anchoring technique (n=42) or the conventional elliptical technique (n=36). One side of the lesion was removed via en bloc resection up to the superficial fascia. The other side of the lesion was removed via de-epithelialization. The de-epithelialized dermal flap was then fixed by suturing it to the superficial fascia on the opposite side. The length of the lesion’s long axis and amount of scar widening were measured immediately after surgery and at 2, 6, and 12 months postoperatively. At 12 months, patients were assessed using the Patient and Observer Scar Assessment Scale.Results The lesion locations included the face, arms, legs, back, and abdomen. The anchoring method resulted in shorter and smaller scars than the conventional method. There were no cases of postoperative hematoma or wound dehiscence. Significant differences in postoperative scar widening were found in the arm and leg areas (P<0.05).Conclusions The anchoring method introduced in this study can provide much better outcomes than the conventional method. The anchoring method is particularly useful for the removal of CMN around the joints or extremities, where the surgical site is subjected to high tension.