Quilting sutures for nasal septum

Abstract

Suturing of the nasal septum after septal surgery is a commonly performed procedure designed to prevent complications such as septal haematoma and bleeding. It is also useful for closing any inadvertent tears of the septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. In addition, the suture can be placed through the middle turbinates, stabilising them during the healing process. Placing knots for interrupted sutures in the posterior and middle part of the nasal septum can be technically difficult. We describe a continuous suturing technique for approximating the mucosal flaps following septal surgery.Key words: Nasal Septum; Otorhinolaryngologic Surgical Procedures; Sutures; Haematoma Introduction Many surgeons are adopting an increasingly conservative approach to septal surgery, such that only the deviated portion of the septum is addressed by the surgery. A number of centres are practising endoscopic techniques to perform septal surgery. Following removal of the deviated cartilage or bony septum, a dead space exists. In order to reduce this dead space, and therefore reduce the risk of developing a septal haematoma, surgeons have used nasal packing and suturing techniques. Several suturing techniques have been described to approximate the mucosal flaps after septal procedures, 1 -3 in order to reduce the complication rate. Many surgeons use interrupted sutures using absorbable suture materials to keep the flaps together. In 1984, Sessions 1 reported continuous suture quilting, using 4.0 plain catgut on a small cutting needle to approximate the mucosal flaps. A similar technique using a curved needle was described by Lee and Vukovic. 2 These techniques also help to close any mucosal tears and support the remaining cartilage. Many surgeons use suturing techniques to obviate the need for packing after surgery. 1 In addition, this suturing technique can be used to stabilise the middle turbinates during the healing process, preventing early lateralisation of the turbinate with adhesion formation.We describe a new, endoscopic suturing method for septal mucosal flaps following septal surgery.

Is nasal packing necessary after septoplasty? A meta‐analysis

“…Gottschalk, in 1978, described a modified suture technique, and found only 2 minor postoperative complications in cohort of 204 patients with septoplasty. Others have described modified techniques of the transseptal suture . Lemmens and Lemkens, Bajaj et al, and Ardehali and Bastaninejad all found the transseptal suture to be as effective as nasal packing in preventing postoperative complications such as hematoma and perforation.…”

Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives

“…Transseptal suture technique is described as a valid and comfortable alternative for packing. Quilting sutures are commonly described as continuous sutures in the literature [4,5,7]. However, we applied two to four horizontal, vertical or oblique separate sutures, changing according to the elevated parts of the septum.…”

“…Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of the septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. In addition, the sutures can be placed through the middle turbinates, stabilizing them during the healing process after endonasal surgeries [5]. Despite the fact that transseptal suturing has repeatedly been compared with nasal packing from diVerent aspects, we additionally evaluated their eVects on patients from an anaesthesiological perspective in this study.…”

Triangular excision and submucosal rejoining to correct horizontally folded caudal nasal septum

“…This submucosal suture‐burying technique was also useful when a septal batten graft was placed. For membrane approximation methods such as quilting sutures, absorbable materials such as plain catgut or polyglactin are generally used, and thus no submucosal suture‐burying technique is needed . To obtain prolonged stability of the rejoined cartilages or fixated grafts, by contrast, we used polydioxanone sutures, which are absorbed more slowly than polyglactin sutures.…”