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What are the benefits and drawbacks of using adjustable sutures in surgical correction of pediatric strabismus?

13:52 EST 1 Dec 2016 | Healio

PointI can understand why many surgeons are not comfortable using adjustable sutures in children. It can be difficult to assess alignment in the immediate postoperative period, there are additional logistics to arranging for a second (if brief) anesthesia to perform adjustment, and we are not always sure about our postoperative alignment target. For these reasons, I do not use adjustable sutures in more straightforward pediatric cases. But when a child is returning for a second or third operation, or when there is a previous postoperative surprise or an incomitant deviation with restriction or paresis, it is essential for me to have a second chance to fine-tune the alignment after the procedure. Parents, too, are reassured when I put the adjustable option on the table. Although adjustable sutures do not give perfection, most studies document improvement in reoperation rates by about 10%. While I do not always know when the postoperative alignment is right, I do know when it is wrong, and I am glad to be able to send nearly every patient home close to the targeted angle. Furthermore, using short tag noose adjustables, the sutures are buried under conjunctiva; in my hands, 75% of these patients require no postoperative suture manipulation, and there is the option of performing a 5-minute adjustment with mask anesthesia in the operating room up to a week after surgery. It only takes a few extra minutes to add the short tag noose adjustable suture during a procedure, so why not offer that option to the family of a child with complex strabismus?

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