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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.
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]

Search 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.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Karounis H et al 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)
Shetty P.C, Dicksheet S et al. 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
Holger JS 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.
Mouzas GL et al 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

Comment(s)

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.

Editor Comment

KMJ

Clinical Bottom Line

Absorbable sutures are effective and safe to use in the closure of traumatic skin wounds.

References

1. 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 Academic Emergency Medicine 2004 July vol 11/7 (730-5)
2. Shetty PC,Dicksheet S,Scalea TM Emergency department repair of hand lacerations using absorbable vicryl sutures Journal of Emergency Medicine Sep 1997, vol./is.(673-4)
3. Holger JS, Wandersee SC, Hale DB Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable and non absorbable sutures. American Journal of Emergency Medicine July 2004, 22/4(254-7)
4. Mouzas GL, Yeadon A. Does the choice of suture material affect the incidence of wound infection? British Journal of Surgery Dec 1975, vol62 (952-5)