5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial

Abstract

Background: Surgeons have mixed opinions regarding cosmetic outcomes of 5-0 fast absorbing plain (FG) gut relative to nonabsorbable suture material, such as 5-0 polypropylene (PP). High quality randomized trials comparing these two suture materials are lacking.Objectives: To determine whether the use of PP during layered repair of linear cutaneous surgery wounds improves scar cosmesis compared to wound closure with FG.Methods: A randomized, split wound, comparative effectiveness trial was undertaken. Patients were evaluated 3 months after the intervention by two blinded physicians using the validated patient observer scar assessment scale (POSAS). Patient assessments were also captured using the same instrument as well as scar width and complications. Results:The mean sum of the six components of the POSAS was 10.26 vs 12.74 for PP and FG, respectively, significantly (p<0.001) in favor of PP. Mean observer overall opinion similarly showed better outcomes for PP than for FG (1.88 vs 2.52, respectively (p<0.006)). The mean sum of the patient assessed components of the POSAS for PP and FG was 12.3 vs 14.34, respectively (p=0.11). Patient overall opinion significantly favored PP (2.41 vs 3.14, p=0.043). Scar width was similar in both arms, 1.25 mm for PP and 1.47 mm for FG (p=0.17). Most patients reported very low pain scores during suture removal (mean 1.63 in scale of 1-10).

Dermatological surgery: an update on suture materials and techniques. Part 1

“…By contrast, a randomized blind‐evaluator trial ( n = 44) suggested that overall patient opinion favoured nonabsorbable sutures 7 . This study compared absorbable (fast‐absorbing plain gut) with nonabsorbable (polypropylene) sutures.…”

“…By contrast, a randomized blind-evaluator trial (n = 44) suggested that overall patient opinion favoured nonabsorbable sutures. 7 This study compared absorbable (fast-absorbing plain gut) with nonabsorbable (polypropylene) sutures. A small but statistically significant better cosmetic outcome was reported with nonabsorbable sutures (P < 0.001).…”

Interrupted subcuticular suture spacing during linear wound closures and the effect on wound cosmesis: a randomized evaluator-blinded split-wound comparative effectiveness trial

“…The power analysis tested the alternative hypothesis that, compared with 2‐cm subcuticular suture, 1‐cm subcuticular suture would result in a better cosmetic outcome, as measured by the primary outcome. A priori power analysis assumptions were a minimal meaningful clinical difference of 3 points on the 60‐point POSAS scale, 90% power, an alpha level of 0·05 and SD of 6, as seen with previous studies performed by the authors 1–3,5 . Using a paired t ‐test with two tails and expecting an attrition rate of 20%, it was determined that we needed to enrol 50 patients.…”

“…Prior studies have compared the use of various wound closure methods and materials, yet there are no studies comparing the aesthetic outcome of subcuticular suture spacing. [1][2][3][4][5][6][7][8][9][10] The goal of this study was to determine whether wound halves closed with 1-cm spaced subcuticular sutures would result in better cosmetic outcomes than halves closed with 2-cm spaced subcuticular sutures. Given the lack of prior studies or standards on subcuticular suture spacing, the 1-cm vs. 2-cm interval was chosen based on the senior author's perception of the common range of subcuticular suturing distances observed during his clinical practice over the past 19 years.…”

“…A priori power analysis assumptions were a minimal meaningful clinical difference of 3 points on the 60-point POSAS scale, 90% power, an alpha level of 0Á05 and SD of 6, as seen with previous studies performed by the authors. [1][2][3]5 Using a paired t-test with two tails and expecting an attrition rate of 20%, it was determined that we needed to enrol 50 patients.…”