Monday, November 29, 2010

Suture Material and Skin Irritation

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

I have written about Suture Allergy vs Suture Reactivity so was very interested in this new article accepted for publication in the journal of Plastic and Reconstructive Surgery (online ahead of publication). 
The article comes from researchers in Greece who chose to use digital image analysis to evaluate the erythema  associated with tissue reaction to suture material. 
The sutures evaluated were polydioxanone (PDS II(R), Ethicon, Sint-Stevens-Woluwe, Belgium), polypropylene blue (Polypropylene(R), Assut Sutures, Ascheberg-Herbern, Germany), polyamide 6 (Ethilon(R), Ethicon, Neuchatel, Switzerland), metallic clips (APPOSETM, ULC Tyco, Hampshire, UK), and polyglactin (Vicryl Rapid(R), Ethicon, Norderstedt, Germany).
Digital photos of 100 patients(70 females, 30 males; all Caucasian) were compared by software, evaluating red color superiority (mean value of red color) in the region surrounding the wound.  Most of the patients were Fitzpatrick skin type II and III (46 and 47 respectfully).  Mean age was 42 years old, ranging from 15 to 86 years. Each underwent the excision of cutaneous and subcutaneous lesions.
Surgical wounds included those after excision of skin or subcutaneous lesions on the face (68%), neck (14%), abdominal wall (12%), axilla (1%) and back (5%). All other anatomical areas were excluded from this study in order to produce sample homogeny as concerns the healing of skin wounds in different body areas.
The researchers excluded wounds which could not be primarily closed without tension or were located over a bony prominence to minimize other confounding factors as were wounds with any kind of post-operative complications, e.g. hematoma, dehiscence or infection for the same reason.
The researchers used two different suture materials in each patient to improve comparison between suture material and skin type.  This was done by dividing each surgical wound into two halves.  Each half was sutured with two different suture materials for each wound. The same number of sutures were used on each half of the wound.  The patients were randomly assigned a pair of suture materials by the means of a sealed envelope method.
The pairing of five different kinds of suture material yielded ten pairs (PDS II- Polypropylene, PDS II - Ethilon, PDS II -metallic clips, PDS II – Vicryl Rapid, Polypropylene - Ethilon,  Polypropylene-metallic clips, Polypropylene-Vicryl Rapid, Ethilon - metallic clips, Ethilon – Vicryl Rapid, metallic clips-Vicryl Rapid).
Each pair was tested on ten patients.  Sutures were removed on the 10th post-operative day.
According to the aforementioned comparisons polydioxanone was found to have the best performance, followed by polyglactin, polyamide, polypropylene and metallic clips. All the above mentioned differences between suture materials were statistically significant (p<0.05).
Their conclusions:
The absorbable sutures used for skin closure in our study were removed after the period of time which is indicated for non-absorbable suture material and respective to the site of the wound. Less skin erythema was observed after the use of absorbable materials (polydioxanone and polyglactin) than with the three nonabsorbable materials (polypropylene, polyamide and metallic clips).
This leads to the conclusion that, when used in skin closure and removed after 10 days, absorbable materials produce less tissue reaction in the form of erythema than non-absorbable sutures do.
So their small study would indicate that PDS II created the least skin redness at 10 days, followed by Vicryl Rapid, Polypropylene, Ethilon, and metallic clips.

Significant differences in skin irritation of common suture materials assessed by a comparative computerized objective method; Plastic & Reconstructive Surgery: POST ACCEPTANCE, 17 November 2010; doi: 10.1097/PRS.0b013e3182043aa6; Original Article: PDF Only

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