Absorbable sutures are safe and convenient for use in traumatic skin wounds.
Date First Published:
September 25, 2008
Last Updated:
January 8, 2009
Report by:
C Hill, ST4 Emergency Medicine (Queen Alexandra Hospital - Portsmouth)
Search checked by:
Alan Charters, Queen Alexandra Hospital - Portsmouth
Three-Part Question:
In [patients with traumatic skin wounds] is [using an absorbable suture material] associated with a [adverse outcome]
Clinical Scenario:
A 34 year old gentleman presents to the department with a cut to his right arm caused by a knife which slipped during a D.I.Y accident. The wound needs closure with sutures and you wonder if using an absorbable material would provide a more convenient and equally as safe option.
Search Strategy:
Medline 1966-2008 using National Library for Health interface.
Cochrane Library Database of systematic reviews.
Cochrane Library Database of systematic reviews.
Search Details:
Medline
[(Exp *LACERATIONS/ OR Laceration*.ti.ab OR Wound*.ti.ab OR Cut*.ti.ab) AND (Exp *SUTURES/ OR ("Polyglycolic Acid" OR Polyglactin OR Polydioxone OR Polyglyconate).ti.ab)) AND (Exp *TREATMENT OUTCOME/ OR "Treatment Outcome*".ti.ab OR Exp WOUND INFECTION/ OR "Wound Infection*".ti.ab OR "Cosmetic Outcome*".ti.ab)]. LIMIT to human AND English AND All Ages.
Cochrane
[Suture OR Stitch OR Closure]
[(Exp *LACERATIONS/ OR Laceration*.ti.ab OR Wound*.ti.ab OR Cut*.ti.ab) AND (Exp *SUTURES/ OR ("Polyglycolic Acid" OR Polyglactin OR Polydioxone OR Polyglyconate).ti.ab)) AND (Exp *TREATMENT OUTCOME/ OR "Treatment Outcome*".ti.ab OR Exp WOUND INFECTION/ OR "Wound Infection*".ti.ab OR "Cosmetic Outcome*".ti.ab)]. LIMIT to human AND English AND All Ages.
Cochrane
[Suture OR Stitch OR Closure]
Outcome:
Medline
122 Papers found of which 118 were irrelevant or of poor quality. A number of of these papers included outcome data for absorbable sutures vs non absorbable but not in the context of traumatic injury and so were discarded.
Cochrane
82 results. None relevant.
122 Papers found of which 118 were irrelevant or of poor quality. A number of of these papers included outcome data for absorbable sutures vs non absorbable but not in the context of traumatic injury and so were discarded.
Cochrane
82 results. None relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A randomised, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus non absorbable nylon sutures Karounis H; Gouin S; Eisman H; Chalut D; Pelletier H; Williams B. 2004 USA | Paediatric patients (<18yrs) with traumatic facial wounds | Prospective, randomised controlled trial | 10 day review looking at infection, dehiscence, characteristics of wound and overall cosmetic appearance | No difference in optimal wound evaluation scores (WES) 63% vs 49% non-absorbable, (RR 0.73; 95%CI 0.45-1.17) | 35% of patients lost to long term follow-up. |
| 4 month review by a blinded plastic surgeon. | No difference between WES scores. 36% vs 28%, (RR 0.88; 95%CI 73-85) | ||||
| Dehiscence rate | No difference between the groups. (2% vs 11%; p=0.07) | ||||
| Wound infection | No difference between the groups. (0 vs 2; p=0.3) | ||||
| Emergency department repair of hand lacerations using absorbable vicryl sutures Shetty PC,Dicksheet S,Scalea TM 1997 USA | Patients of all ages with traumatic skin wounds | Prospective, randomised controlled trial | Complications or infections | No reported complications in either group | |
| Quality of scar formation | No difference in scar formation | ||||
| Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable and non absorbable sutures. Holger JS, Wandersee SC, Hale DB 2004 USA | Patients of all ages with traumatic facial lacerations | Prospective randomised controlled trial | Visual analog score (VAS) of wound measured by two blinded physicians and patient at 9 and 12 months | No significant difference between the VAS scores in each group. Maximum difference 3.6mm, below minimum clinical important difference of 10-15mm. | 42% of patients lost to follow-up. |
| Does the choice of suture material affect the incidence of wound infection? Mouzas GL, Yeadon A. 1975 UK | Patients of all ages with traumatic skin wounds | Prospective randomised controlled trial | Rates of postoperative tissue reaction and wound infection | No difference between rates of complications between polyglycolic acid and nylon. Slightly higher rates of infection with silk. | Short term follow-up |
Author Commentary:
Using an absorbable suture material is not associated with increased infection or dehiscence rates and the cosmetic outcome is comparable to using nonabsorbable sutures.
As absorbable sutures do not require removal this has important benefits to both the patient and health service in cutting costs and avoiding the inconvenience of suture removal. In children this would have an even greater impact on avoiding emotional trauma.
As absorbable sutures do not require removal this has important benefits to both the patient and health service in cutting costs and avoiding the inconvenience of suture removal. In children this would have an even greater impact on avoiding emotional trauma.
Bottom Line:
Absorbable sutures are effective and safe to use in the closure of traumatic skin wounds.
References:
- Karounis H; Gouin S; Eisman H; Chalut D; Pelletier H; Williams B.. A randomised, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus non absorbable nylon sutures
- Shetty PC,Dicksheet S,Scalea TM. Emergency department repair of hand lacerations using absorbable vicryl sutures
- Holger JS, Wandersee SC, Hale DB. Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable and non absorbable sutures.
- Mouzas GL, Yeadon A. . Does the choice of suture material affect the incidence of wound infection?