Comparing the running subcuticular technique versus the Donati technique in open carpal tunnel release: a randomized controlled trial

Abstract

Background There are various skin suture techniques for wound closure following carpal tunnel release, and well-performed suturing will result in low post-operative scar tenderness. The aim of this study was to compare the Donati suture technique and running subcuticular technique in terms of surgical scar, post-operative pain and functional outcome in open carpal tunnel release. Methods One-hundred forty-two patients were randomized using a computer-generated random number table into two groups receiving either running subcuticular suturing or Donati suturing after surgical intervention. We evaluated postoperative scarring using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Boston Carpal Tunnel Questionnaire after surgical decompression for carpal tunnel syndrome at 2, 6, and 12 weeks. Continuous data are reported as mean ± SD while normally distributed or as median (interquartile range) when the distribution was skewed. Results Lower scores at 2 weeks were given by the patients receiving the running subcuticular suture technique than the Donati suture technique (15.3 ± 4.8 vs 17 ± 4.6, respectively, P < 0.05) while the observer scores were not significantly different (15.6 ± 5.8 vs 16.7 ± 5.2, respectively, P = 0.15). At both 6 and 12 weeks post-surgical decompression both patient and observer scores were not significantly different. There were no differences between the groups in terms of VNRS pain scores and functional Boston Carpal Tunnel Scores at all time points. Conclusions This randomized controlled trial found that although scarring assessments were slightly better in the earliest period following wound closure after surgical decompression in carpal tunnel syndrome using the running subcuticular suture, the final results at 3 months postoperative were not significantly different. Trial registration The study was registered at https://www.thaiclinicaltrials.org/ (TCTR20191204002).

Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release

“…From the 506 titles and abstracts identified in the searches, we fully reviewed 106 articles where the primary reasons for exclusion were retrospective study design (30), insufficient sample size (29), or the lack of information on the specific CTR technique (12). The meta-analysis included 23 studies, 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 involving 2,303 patients from 15 countries, representing a best-evidence synthesis of mOCTR literature published over the past decade ( Supplementary Figure 1 ). The median age of participants was 55 years (study-wide range was 35–63 years), most were women (median 74%; study-wide range was 50%–100%), and the median CTS symptom duration before surgery was 12 months (study-wide range was 5–57 months; Table 1 ).…”

Treatment and Improvement of Healing after Surgical Intervention

“…For the subcuticular closure, absorbable filaments were used, such as monocryl [28,29,32,36], polydioxanone [23], and vicryl [25,30,31,35,38,40]. Also, the skin sutures were made with nylon [24,32,35,39], Ethicon [23,[28][29][30], and monocryl [36,40]. However, not all studies specified the materials used.…”

Effect of Intra-operative glove changing during Cesarean on Post-operative Complication (Clinical Trial)

“…Section: Skinin cision(Scapal) (figure 1), sub cutaneous tissue layer figur(1), Fascial layer, rectus muscle layer, opening the peritoneum (Avoiding visceral injury) (9) , intraabdominal procedure: Bladder flap, Hysterotomy(Transverse incision), expanding the incision and uterine stapler 9 , fetal extraction, cord clamping, placental delivery as in figur (4), surgical gloves were changed for surgeon and assistant, prevention of PPH, uterine closure, exteriorizing the uterus, closure abdominal wall in layers, closure sub cutaneous, the skin was closed by non-absorbable poly proline (0-3), the |Patients were followed up after one weeks for removal of skin suture evaluate the skin and scar for primary outcomes and the Patient had followed for 6th weaks for secondry outcomes. (10) Fig. 1: site of transversr incision (11) Every patient was subjected to: Careful and detailed history taking which include: Name, age, residence, first day of last menstrual history, parity, gravidity, past history of diabetes or hypertension.…”