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Original Article
Comparative analysis of 6‑0 nylon and 6‑0
vicryl rapide in congenital unilateral cleft lip
repair
J. K. Dayashankara Rao, Payal Luthra, Varun Arya, Vijay Siwach, Anil Sheorain,
Priyanka Mudgal
ABSTRACT
Context: The type of suture material used in surgery
has been a long standing debate among surgeons.
In this study we compared rapidly absorbable suture
material (Vicryl RapideTM or Irradiated Polygalactin
910) with non-absorbable suture material (Nylon
or Polyamide) in patients with nonsyndromic
congenital unilateral cleft lip. Aims: To compare the
appearance and course of scar, wound infection and
patient’s parent perception between the two groups.
Settings and Design: Randomized prospective
controlled study. Materials and Methods: 20 patients,
in the age group of 3-18 months were randomly
allocated to two groups with 10 patients each.
Skin suturing was done with 6-0 Polyamide and 6-0
Irradiated polygalactin the respective groups. Patients
were evaluated at 1 week, 1 month, 3 months, 6 months
and 1 year postoperatively by the observer as well as
by the patient’s parent. Results and Conclusion: It
was found that Vicryl Rapide showed poorer cosmetic
outcomes regarding height and pigmentation of scar
as compared to nylon sutures.However, this sample
size and follow-up period is very small to generalize
these findings.
Key words: Absorbable, chieloplasty, irradiated
polygalactin 910, polyamide, sutures
INTRODUCTION
Cleft lip patients undergo multiple surgical interventions
at a very young age which poses a great challenge for
the surgeons to find effective techniques and suture
materials for best results. Some prefer nonabsorbable
Department of Oral and Maxillofacial Surgery, Faculty of Dental
Sciences, SGT University, Gurgaon, Haryana, India
Address for correspondence:
Dr. Payal Luthra,
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences,
SGT University, Gurgaon ‑ 122 505, Haryana, India.
E‑mail: drpayal.maxfac@gmail.com
© 2016 Journal of Cleft Lip Palate and Craniofacial Anomalies | Published by Wolters Kluwer - Medknow
Access this article online
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DOI:
10.4103/2348-2125.187512
Quick Response Code:
suture material because of its easy handling and a
minimal inflammatory response[1] while the others
prefer absorbable sutures so as to preclude the need
of additional procedures such as sedation or general
anesthesia and distressing the child.[2]
Nylon is a synthetic, nonabsorbable, monofilament
suture which has low tissue reactivity and high‑initial
tensile strength which degrades to 50% by 1–2 years.[3]
Vicryl rapide is a synthetic suture which shows enhanced
absorption in vivo due to effect of gamma radiation.[4]
Since suture removal in these children is a great concern
for both the surgeons and parents,[5] we conducted a
study to compare the appearance and course of scar
and wound infection using an absorbable suture (vicryl
rapide) and a nonabsorbable suture (nylon) for skin
closure in such patients.
MATERIALS AND METHODS
Twenty patients in the age group of 3 months to
18 months with nonsyndromic congenital unilateral cleft
lip (complete or incomplete) were enrolled in the study.
The patients were randomly allocated to Group A (closure
with 6-0 Polyamide) and Group B (closure with 6-0
vicryl rapide). Informed consent was obtained from
parents before surgery. The study was approved by
the Institute Ethical Committee. Cleft lip repair was
performed by the same surgeon in all patients using
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Cite this article as: Dayashankara Rao JK, Luthra P, Arya V, Siwach V,
Sheorain A, Mudgal P. Comparative analysis of 6-0 nylon and 6-0 vicryl rapide
in congenital unilateral cleft lip repair. J Cleft Lip Palate Craniofac Anomal
2016;3:83-6.
83
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Rao, et al.: Nylon versus vicryl rapide in congenital cleft lip

Table 1: Observer’s evaluation proforma

Patient’s name: ––––––––––––
OPD number: ––––––––––––
Age/sex: ––––––––––––
Date: ––––––––––––
Date of surgery: ––––––––––––
Follow‑up number: ––––––––––––
Scar Score obtained
characteristics
Vascularity Normal 0
Pink 1
Red 2
Purple 3
Pigmentation Normal 0
Hypopigmentation 1
Hyperpigmentation 2
Pliability Normal 0
Supple 1
Yielding 2
Firm 3
Ropes 4
Figure 1: Patient photographs for Group A Contracture 5
Height (mm) Flat 0
<2 1
Modified Millard’s rotational advancement technique and
2–5 2
primary rhinoplasty in the complete cleft lip. All patients >5 3
in Group A required general anesthesia or sedation for Width (mm) <2 0
removal of sutures on the 7th postoperative day. Patients >2 1
in both groups were evaluated in person using a scale Wound infection Absent 0
which was modified from Vancouver scar scale [Table 1] Present 1
for observer’s assessment and from patient and observer
scar assessment scale [Table 2] for assessment of patient’s Table 2: Patient’s parent evaluation proforma
parents’ perception. Patients were followed and evaluated Patient’s name: ––––––––––––
at 1 week, 1 month, 3 months, 6 months, and 1 year. OPD number: ––––––––––––
Descriptive statistical analysis using IBM Corp. Released Age/sex: ––––––––––––
Date: ––––––––––––
2011. IBM SPSS Statistics for Windows, Version 20.0. Date of surgery: ––––––––––––
Armonk, NY: IBM Corp., was performed. P = 0.05 or less Follow‑up number: ––––––––––––
was considered clinically significant. Criteria Normal skin worst scar imaginable should
correspond to 10
RESULTS 1 2 3 4 5 6 7 8 9 10
Pain in scar
The average age of the patients was 10.3 months Itching in scar
Color of scar
in Group A and 6.6 months in Group B. According
Stiffness of scar
to the observer, the difference between two groups Thickness of scar
was significant regarding pigmentation and height Mild: 1-3, Moderate: 4-7, Severe: 8-10
of scar at the end of 3 months, 6 months, and 1 year
[Figure 1 and 2] with P < 0.05; the values being higher in hyperpigmented scars in vicryl rapide group with
irradiated polyglactin 910 group [Table 3]. The pliability statistically significant difference at 3 months, 6 months,
and color of scar are displayed in Tables 3 and 4. and 1 year. This can be attributed to its absorption mainly
through phagocytosis.[7] However, Martelli et al.[8] stated
DISCUSSION that IRPG is not recommended for facial skin closure.

In our study, vascularity of the scar was statistically Pliability[9] was rated in our study on a scale of 1–5 and
insignificant between two groups at all follow‑ups. On was assessed subjectively by applying pressure and
assessing scar pigmentation by applying mild pressure pinching the skin between fingers. Greater fibrosis and
over the scar,[6] we found greater hypopigmented and less elasticity were found in vicryl rapide group with

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Rao, et al.: Nylon versus vicryl rapide in congenital cleft lip

Table 3: Comparison of observer’s evaluation between Group A and Group B

1 week 1 month 3 months 6 months 1 year
Group A Group B Group A Group B Group A Group B Group A Group B Group A Group B
Pigmentation
Normal 8 9 4 6 6 2 8 3 9 4
Hypo 2 1 6 3 4 7 2 6 1 5
Hyper 0 0 0 1 0 1 0 1 0 1
P 0.277 (NS) 0.361 (NS) 0.027 (S) 0.002 (S) 0.010 (S)
Height (mm)
Flat 10 9 7 3 7 2 8 3 8 4
<2 0 1 2 6 2 6 2 5 2 6
2-5 0 0 1 1 1 2 0 2 0 0
P 0.165 (NS) 0.098 (NS) 0.032 (S) 0.008 (S) 0.036 (S)
Pliability
Normal 2 2 5 2 5 1 7 3 9 5
Supple 7 8 0 3 1 2 2 1 0 2
Yielding 1 0 3 3 3 3 0 3 0 2
Firm 0 0 2 2 1 4 1 3 1 1
P 0.330 (NS) 0.292 (NS) 0.029 (S) 0.021 (S) 0.104 (NS)
NS: Nonsignificant, S: Significant (P≤0.05)

Table 4: Comparison between patient’s parent evaluation in Group A and B

1 week 1 month 3 months 6 months 1 year
Group A Group B Group A Group B Group A Group B Group A Group B Group A Group B
Color
Mild (1-3) 10 9 10 10 10 10 10 10 10 10
Moderate (4-6) 0 1 0 0 0 0 0 0 0 0
Severe (7-10) 0 0 0 0 0 0 0 0 0 0
P 0.309 (NS) 0.017 (S) 0.004 (S) 0.0005 (S) 0.027 (S)
Pain
Mild (1-3) 10 7 10 10 10 10 10 10 10 10
Moderate (4-6) 0 3 0 0 0 0 0 0 0 0
Severe (7-10) 0 0 0 0 0 0 0 0 0 0
P 0.002 (S) 0.313 (NS) 0.165 (NS) 0.165 (NS) 0.165 (NS)
NS: Nonsignificant, S: Significant (P≤0.05)

statistically significant difference at 3 months (P = 0.029)

and 6 months (P = 0.021) and nonsignificant at 1 year
as the scar became older which may be attributed to
increased tissue activity.[10] Patient’s parents’ perception
which mainly concerns appearance was in contrast to
the observer’s evaluation regarding stiffness.

Evidence states that the scar height and width depend

on the extent of tissue reaction and the amount of
wound tension and may lead to the formation of
hypertrophic scars and keloids.[11] Scar height was
objectively measured as its elevation from the normal
skin plane and was higher in vicryl rapide group with
a statistically significant difference between the two
groups at 3 months (P = 0.032), 6 months (P = 0.008),
and 1 year (P = 0.036). Most of the scars were <2 mm
in height. Width of the scar was measured using a Figure 2: Patient photographs for Group B

Vernier caliper, and we found no statistically significant

difference between the two groups. Sommerlad and monocryl as compared to vicryl rapide causes reduced
Creasey[12] stated that prolonged tissue support by the tension on the scar tissue leading to smaller scars.

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Rao, et al.: Nylon versus vicryl rapide in congenital cleft lip
The presence of sebaceous glands predispose white
roll to postoperative adnexal infections with a higher
possibility in multifilaments due to their braided
structures.[12] Freshwater et al.[13] found no difference in
infection rates between sites sutured with 4‑0 novafil
and 4‑0 vicryl rapide. Tandon et al.[14] noted no cases of
stitch abscesses or other wound complications in their
study of 236 wounds on vicryl rapide. We encountered
only one case of wound infection at 1 week in nylon
group. Early disappearance of vicryl rapide sutures
seemed to be advantageous in this regard.
Analgesic syrups were routinely prescribed to all
patients for 3 days. Pain at the surgical site as rated by
the patient’s parent was more in vicryl rapide group
with a statistically significant difference at 1 week.
CONCLUSION
There are several limitations to our study. Sample size
as well as follow‑up period are small. Another important
limitation is that the sample includes both complete
and incomplete cleft lips which may show different
healing characteristics.
Thus, we conclude that the cosmetic appearance of
cleft lip scar with vicryl rapide is poorer as compared
to the nylon suture of same dimensions at the end
of 1 year. Although vicryl rapide has the distinct
advantage of being the fastest absorbing synthetic
absorbable suture, but providing the patient with a
good cosmetic appearance for a lifetime definitely
deserves more consideration than avoiding a traumatic
surgical procedure for suture removal. However,
studies with larger sample size and longer follow‑up
periods are required to assess the long term influence
of these suture materials on scarring and cosmetic
appearance and thus generalize these findings.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for
his/her/their images and other clinical information to
86 July-December 2016 / Vol 3 / Issue 2
be reported in the journal. The patients understand
that their names and initials will not be published and
due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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