A Randomized, Prospective Trial Evaluating Surgeon Preference in Selection of Absorbable Suture Material
February 2012 | Volume 11 | Issue 2 | Original Article | 196 | Copyright © February 2012
AbstractThis study is the first double-blinded, randomized comparison of two absorbable sutures. To better understand product characteristics and surgeon preference, we conducted a study of two similar-appearing FDA-approved sutures, glyconate and poliglecaprone 25. Four dermatologic surgeons were enlisted. A total of 48 patients with 53 surgical sites were examined. One half of each surgical wound was closed with one type of suture and the other half with the other type. Each half was evaluated for product characteristics. There was no statistically significant difference in surgeon preference for glyconate versus poliglecaprone 25 (P=0.64). Of the cohort preferring poliglecaprone 25, there was a correlation with speed of closure (P=0.06). Of the surgeons that preferred glyconate, we found significantly better visibility (P=0.03), reduced suture breakage during knot tying (P=0.05), and correlation with better handling properties (P=0.06) associated with that preference. The data from this study will enable products to be designed towards these needs and allow surgeons to select sutures that more precisely fit their particular requirements.
J Drugs Dermatol. 2012;11(2):196-201.
Physicians have used sutures to close wounds for at least 4,000 years. Archaeological records from ancient Egypt show that Egyptians used linen and animal sinew to close wounds. In ancient India, physicians used the pincers of beetles or ants to staple wounds shut. They then cut the insects' bodies off, leaving their jaws (staples) in place. Other natural materials used to close wounds include: flax, hair, grass, cotton, silk, pig bristles, and animal gut.
The fundamental principles of wound closure have changed little over 4,000 years. Successful closure of wounds involves surgical techniques coupled with knowledge of the physical characteristics and handling of the suture and needle. The selection of proper suture material in closing any surgical defect is important in wound healing, minimizing infection, and achieving optimal cosmetic and functional results.
A great deal of progress has been made since Egyptian times with regard to suture materials and manufacturing processes. Today, sutures are available with a wide variety of characteristics, configuration, manipulability, coefficient of friction, solubility, strength, and immunogenic properties. Yet, sutures are currently rather crudely classified based on a numeric scale according to diameter and tensile strength; descending from 1 to 10, and then descending again from 1-0 to 12-0. This study aims to explore the factors that are important to a surgeon when choosing sutures via evaluating surgeon preference for two types of synthetic, absorbable, monofilament sutures: glyconate and poliglecaprone 25. We hope to initiate a more nuanced exploration of how suture characteristics influence surgeon preference, beyond filament type and size, and how makers of sutures may better report and represent these factors.
There are two categories of sutures, absorbable and non-absorbable. Most absorbable sutures are absorbed by enzymatic degradation or hydrolysis, and lose at least 50 percent of their tensile strength within two months.1,2 These sutures are generally used as buried sutures to close the dermis and deeper subcutaneous layers; however, they may be used as surface sutures when suture removal is impractical. 1,2 Absorbable sutures provide temporary support and maintain wound-edge approximation until the wound has healed enough to prevent dehiscence or splitting.1 Non-absorbable sutures are mainly used on the surface to align wound edges. They are resistant to enzyme degradation and hydrolysis, and are generally removed 5-14 days post-operatively when wound edges have re-epithelialized.1,2