Comparison of Cosmesis and Cost with Absorbable Versus Non-Absorbable Closure in Minor Hand Surgery
David Anthony Barcel, MD; Justin M Rabinowitz, MD; Ryan Wolf, BS; Kyle Kokko, PhD, MD3
Medical University of South Carolina, Charleston, SC
Background: Carpal tunnel syndrome and stenosing tenosynovitis affect approximately 10% and 2% of the US population. Significant patient anxiety exists with regard to pain and suture removal at initial follow up, and with scar cosmesis during later appointments. As a result, the use of absorbable suture has become increasingly popular. There have been investigations into the cost and clinical outcomes using absorbable vs non-absorbable suture for wound closure in carpal tunnel release (CTR). To our knowledge, there are no studies to date comparing these closure methods in both CTR and Trigger Finger Release (TFR). The current study sought to compare scar cosmesis, cost, time spent removing sutures in clinic, and nursing satisfaction utilizing the two methods of closure in both CTR and TFR.
Methods: 90 patient's were prospectively, and non-randomly enrolled in a two-cohort study based on surgeon suture preference comparing the use of Poliglecrapone (MonocrylŽ) suture (Group I) and the use of a Polyamide (EthilonŽ) suture (Group II) for wound closure following isolated elective CTR (Sub-Group A) or TFR (Sub-Group B). The primary outcome measure for the current study was scar cosmesis using the Stony Brook Scar Evaluation Scale (SBSES). Secondary outcome measures included cost of materials, time spent in clinic at the initial post-operative visit removing sutures, and nursing satisfaction between the two methods of closure. Data analysis was performed using chi square analysis and independent samples t-test.
Results: No significant difference in SBSES scores were found between Groups IA vs. IIA or Groups IB vs. IIB (p=0.534 and p=.502, respectively). There was a significant time savings in clinic when removing sutures between Groups I vs II (mean difference = 13.5 s; p<0.001). Cost comparison between these groups revealed MonocrylŽ to be comparable to EthilonŽ ($4.58 vs $3.00, respectively). There was also improved subjective nursing satisfaction when clinic nurses were surveyed on the use of absorbable vs non-absorbable suture requiring removal in clinic.
MonocrylŽ is cost-effective without compromising cosmetic outcome. The use of absorbable suture offers a significant time savings in clinic improving clinic work flow. Additionally, nursing satisfaction with Monocryl is higher, improving their mood and, as a result, the clinic environment. We would thus recommend the use of a similar absorbable suture for wound closure in minor hand surgery such as CTR and TFR.
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