Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery

Abstract

Summary: There is currently no consensus on the optimal suture type for palmar skin closure following open carpal tunnel release and trigger finger release. We performed a retrospective analysis of patients in the Palo Alto Veterans Affairs (PAVA) Health Care System who underwent these procedures over a 2-year period to compare 30-day wound outcomes following closure with poliglecaprone 25 (Monocryl), nylon, and chromic gut suture. Out of 312 PAVA cases (133 carpal tunnel release, 179 trigger finger release), incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012). On multivariable logistic regression, suture type and diabetes were independent predictors of 30-day wound complications and extra encounters. At PAVA, compared with Monocryl, closures with nylon and chromic were significantly more likely to dehisce and/or become infected [nylon: odds ratio (OR), 5.0; 95% CI, 1.9–13.3 and chromic: OR, 9.3; 95% CI, 2.7–32.4; P = 0.002], and to be associated with an additional encounter (nylon: OR, 2.4; 95% CI, 1.1–5.3 and chromic: OR, 4.5; 95% CI, 1.6–12.9; P = 0.007). This has led to using Monocryl as the standard closure for these cases at PAVA.

Prospective randomized controlled trial comparing the effect of Monocryl versus nylon sutures on patient- and observer-assessed outcomes following carpal tunnel surgery

“…Monocryl has been associated with reduced tissue reaction and inflammation, and has been shown to produce significantly smaller and less hypertrophic scars compared with Vicryl ( Niessen et al., 1997 ). In another recent study, incisions closed with Monocryl in the same fashion as our study (a series of interrupted, deep dermal, 4-0 sutures) were significantly less likely to develop dehiscence, infection or lead to additional wound-related encounters compared with incisions closed with 4-0 nylon or 4-0 chromic gut in mattress fashion ( Rochlin et al., 2019 ).…”

Skin closUre in carPal tunnEl Release (SUPER): protocol for a blinded randomised controlled trial comparing absorbable and non-absorbable sutures in carpal tunnel release

“…Contrary to traditional teaching, absorbable sutures may lead to fewer cases of dehiscence, infections and fewer clinical encounters related to wound-related concerns 19. In conclusion, there is not enough evidence for clinicians to make well-informed decisions regarding the choice of suture material.…”

“…Contrary to traditional teaching, absorbable sutures may lead to fewer cases of dehiscence, infections and fewer clinical encounters related to wound-related concerns. 19 In conclusion, there is not enough evidence for clinicians to make well-informed decisions regarding the choice of suture material. Thus, there is a clear and pressing need for a well-planned, well-executed and adequately powered RCT with reasonably long follow-up periods to compare non-absorbable and absorbable sutures.…”

Effective Things Surgeons Can Tell Patients During Wide-Awake Local Anesthesia No Tourniquet Surgery to Decrease Complications and Improve Outcomes

“…I tell them it will also increase the chances of infection, especially if the patient has transcutaneous skin sutures. 1 …”