Knotless Suturing with Polypropylene (Prolene) Suture

It’s not every day that an oculoplastic surgeon is inspired by a cataract doctor, but I was when I saw the use of a thermal cautery to create a flange on the end of a polypropylene haptic.  Using this technique in skin suturing obviates the creation of a knot, which can sometimes distort the tissue.  Either a high or low temperature cautery can be used. 

This is Richard Allen at oculosurg.com.  This video demonstrates a knotless suturing technique with polypropylene suture.  I actually stole this idea from the cataract doctors.  I was watching a lecture on the Yamane technique and the surgeon used a thermal cautery to make a flange on the end of the polypropylene haptics.  I thought “well, that was interesting”.  This video demonstrates a similar technique with skin suturing.  The suturing is performed through the skin, but rather than tying a knot, a thermal cautery is used to melt the suture.  The knob of molten polypropylene is then flattened with the needle holder.  This holds the suture in position, and the suturing proceeds as normal.  At the end of the suturing, the suture is fixated at the exit from the skin and the cautery is performed again.  A high or low temperature cautery can be used.  In this video, a high temperature cautery is used.  I believe the low temperature cautery gives a little more control.  This procedure obviates tying knots, which can sometime distort the wound.  A Burrow’s triangle is excised medially and a single knot is used to close this area.  The technique is then performed again.  The cautery should not touch the suture, but get close to it.  The closer to the suture, obviously, the faster it will heat up.  The needle holder is used to flatten the flange.  Postoperatively, the flange appears sturdy.  The suture can be cut at one of the flanges and then pulled out from the remaining flange.