Basic And Clinical Research On The Role Of Different Suture In The Neck Scar Formation After Thyroid Surgery

Objective: To compare the influence on applying different suture in the neck scar formation after thyroid surgery. Thyroid gland is the important endocrine gland of human body, which can generate many kinds of diseases included metabolic,functional,tumorous,phlogistic and so on. Almost all the thyroid diseases reveal lump,most of lump need to be treated by operation. Neck is the place exposed to outside where the operative incision just located. After operation, it will left a 6 cm scar on the neck, which severely influence beautiful outlook. It is a psychic burden to the patient, which can even influence patients'living. Especially to those people who have scar constitution,after thyroid surgery,the large and saturate postoperative scar is badly unsightly. To these patients, we can cut the scar and make intradermic suture, then make low dose radiotherapy to them after one week. But, this way is very complicated and it is a painful experience to the patients. Result from this reason, some patients don't want to accept thyroid surgery, which lead to the lump become more and more large. Some lump can even become canceration and threat to life. In this research, we apply different suture to dermatic saturation for patients who accepted thyroid surgery and to saturation for rats'skin, comparing the volume of postoperative scar from the patients and the number of inflammatory cells and collagenoblasts from the rats'scar, accordingly comparing which kind of suture can make the nick accrete best and make the scar smallest. Thereby, to chose the best suture to sew up the cervical nick.Methods:1 The group of patients: 60 patients who will experience ablation of thyroid, weight 60-70 kg, male-female not be limited, were randomly allocated into three groups. Group PROLENE suture (sutured subcutaneous tissue with type 0 common suture, sutured skin by intradermic suture with PROLENE suture) ; Group antibiosis VICRYL suture (made by which is absorption line, sutured subcutaneous tissue by interrupted suture and sutured skin by intradermic suture with antibiosis VICRYL suture) and Group common suture(sutured subcutaneous tissue by interrupted suture and sutured skin by intradermic suture with common suture). All the pattern number of the suture are equal to type 0 common suture. sutured out 6 days after operation, antibiosis VICRYL don't need to sutured out. One month after operation, fluped these patients, appiying B- sonicator to accurately measure the thickness and wdth of the scars of the patients'necks. The length of scars can be measured by scale. From the midpoint of the scar,surveyied 3cm on every side. So the length of scars were all be considered 6cm.Then calculate the volume of scars(length×wdth×thickness). The element is cm3.2 The group of animals: 10 healthy male Wistar rats ,weight 210-300g. Make three incisions with the same length on the rats'abdomens,reach to muscular layer. Sutured the three incisions with the three sorts of suture. All the incisions were allocated into three groups on the basis of the category of the suture. Group PROLENE suture; Group absorbable suture and Group common suture. 10 incisions every group. All the pattern number of the suture are equal to type 0 common suture. The methods of suturation refer to the group of patients. sutured out 6 days after operation,( antibiosis VICRYL don't need to sutured out). Three weeks after operation, to draw the materials (scars) from the rats'abdomens. Making HE tinction after cutting sheet. Observing the number of inflammatory cells by microscopy (to count the number of inflammatory cells in tissue by microscope×400 elect 5 high power field to count get the mean value ). Then made immunohistochemistry score and FGF-2 positive cells counting for collagenoblasts(5 highpower field).3 Statistical treatment: Stereometry of scars apply the method of analysis of variance and SNK-q test; To survey and evaluate the number of inflammatory cells and the IHS value of collagenoblasts with the method of ANOVA (SNK-q test). P<0.05 were considered statistical significance. ( statistical treatment:use the SAS 8.00).Results:(1)There are significant difference on the volume of scars among the three groups of patienes. The volume of scars sutured by absorbable suture (0.68±0.21cm3)is smaller than the scars'volume of the PROLENE group(0.83±0.13cm3) and the group of common suture (2.03±0.31cm3) (P<0.01). The volume of scars sutured by PROLENE suture is smaller than the scars'volume of common suture(P<0.01);(2)There are significant difference on the number of inflammatory cells and the IHS value of collagenoblasts among the three groups of suture. The number of inflammatory cells in the scars sutured by absorbable suture(16.30±4.42) and PROLENE suture(49.00±18.89) is fewer than the number of the common suture group (182.20±66.57)(P<0.01). But There are no statistical difference on the number of inflammatory cells between the group of absorbable suture and the group of PROLENE suture(P>0.05);the IHS value of collagenoblasts in group of absorbable suture(1.89±0.93) is fewer than the PROLENE group(5.20±1.03) and the group of common suture (9.00±0.00) (P<0.01), the IHS value of collagenoblasts in group of PROLENE suture is fewer than the group of common suture (P<0.05).Conclusions:1 any suture can not avoid the form of postoperative scar ;2 Apply antibiosis VICRYL (absorption line) suture and PROLENE suture to suture the incisions on patients'necks can relieve inflammatory reaction of incision compared to common suture; There are no statistical difference on relieving inflammatory reaction of incision between the group of antibiosis VICRYL suture and the group of PROLENE suture ;3 PROLENE suture can form fewer collagenoblasts and smaller scar on postoperative incisions than common suture. antibiosis VICRYL suture can form the fewest collagenoblasts and the smallest scar on postoperative incisi ons.