Dermatological surgery: an update on suture materials and techniques. Part 1

Abstract

Significant variation exists in the surgical suture materials and techniques used for dermatological surgery. Many wound-closure techniques are now practised, including use of sutures, staples and topical adhesives. The focus of our review article is to summarize the latest evidence relating to suture materials and wound-closure techniques, considering the following areas: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases Medline, PubMed and Embase using the keywords 'skin surgery', 'dermatologic surgery', 'sutures', 'suture techniques', 'suturing techniques' and 'surgical techniques' to identify relevant English-language articles. Absorbable superficial sutures may be a preferred alternative to nonabsorbable sutures by both patients and surgeons. Subcuticular sutures may be preferable to simple interrupted sutures for superficial wound closure, and there may also be a role for skin staples in dermatological surgery, particularly on the scalp. However, there remains limited evidence specific to dermatological surgery supporting the use of particular suture materials and suturing techniques. Further high-quality research is required, including multicentre randomized trials with larger cohorts.

The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications

“…26 Although RSC has been shown to have superior wound perfusion and cosmesis across multiple surgical subspecialties, its effect on postoperative wound complications in orthopaedic surgery is scarce and conflicting. [13][14][15][16][17][18][19][20][21] A meta-analysis of 6 studies by Smith et al 4 found that the risk of postoperative wound complications was 3.8 times greater for patients who received staples compared with those who received sutures. A subsequent systematic review and meta-analysis of 12 studies by Krishnan et al 5 found no differences in the rate of wound complications between these groups.…”

“…4–14 More recently, studies in multiple surgical subspecialities have demonstrated that running subcuticular closures (RSC) result in improved wound perfusion and cosmesis when compared with staples or cutaneous mattress suture closures (CMC). 15–21 However, the use of RSC in orthopaedic trauma remains poorly studied and rarely used because of concern for increased risk of wound complications. 1,9,11,13,22…”

“…[4][5][6][7][8][9][10][11][12][13][14] More recently, studies in multiple surgical subspecialities have demonstrated that running subcuticular closures (RSC) result in improved wound perfusion and cosmesis when compared with staples or cutaneous mattress suture closures (CMC). [15][16][17][18][19][20][21] However, the use of RSC in orthopaedic trauma remains poorly studied and rarely used because of concern for increased risk of wound complications. 1,9,11,13,22 The purpose of this study was to compare the rate of postoperative wound complications and wound-related reoperations before and after the implementation of an RSC protocol for orthopaedic trauma procedures.…”

Comparing running vs interrupted sutures for skin closure: A systematic review and meta‐analysis

“…Once infection occurs, the whole stitch needs to be removed, hindering the healing process. 25 , 26 , 27 Pus could be drained by selectively removing a single stitch in interrupted sutures.…”

Recent Advances in Nano-Formulations for Skin Wound Repair Applications

“…In addition, it shows low efficiency; it is difficult to control the absorption period and ensure that the sutures begin to degrade after wound healing. [15][16][17] (2) Medical adhesives, widely used in clinical practice, are prone to promoting rash or skin abnormalities after use, and some of them exhibit defects, such as a brittle adhesive layer, formaldehyde production during decomposition and poor air permeability. 18,19 (3) Although wound dressings can temporarily protect the wound, prevent contamination, promote healing and provide a suitable environment for the process of wound healing and treatment, they have the defects of a short efficacy duration and uneven sustained release.…”