Increased wound complications in glabrous skin with absorbable sutures following carpal tunnel and trigger finger release

Abstract

Purpose

With no clear consensus on absorbable verses non-absorbable suture-usage for glabrous skin closures, the purpose of this study was to investigate whether incisions closed with Monocryl sutures displayed higher wound complication rates than nylon sutures following carpal tunnel and trigger finger release surgery.

Methods

A total of 155 carpal tunnel or trigger finger release surgeries in 138 patients performed in an outpatient academic medical center were analyzed. Patients with pre-operative trauma or infection, or who received concurrent surgeries were excluded. Incisions were closed using either 4–0 poliglecaprone 25 (Monocryl) or 4–0 nylon (Ethilon). Suture choice was determined via a pseudo-randomized method: Monocryl sutures were utilized in surgeries performed on even dates (e.g. 4/10/2024) and nylon sutures on odd dates (e.g. 4/11/2024). The medical records were reviewed for demographics and wound-related complications occurring within 90 days post-surgery. Criteria including additional medical encounters, co-morbidities, and assisting resident level-of-training between Monocryl and nylon cohorts were also evaluated for differences in complication rates.

Results

There were 86 carpal tunnel release (55.5 %) and 69 trigger finger release (44.5 %) surgeries. The average age at surgery was 62.4 ± 11.6 years, with Monocryl used in 73 (47.1 %) and nylon in 82 (52.9 %) procedures. The rates of infection requiring antibiotics were similar between Monocryl (4.1 %, n = 3) and nylon cohorts (2.4 %, n = 2). However, higher rates of dehiscence were observed with Monocryl (11.0 %, n = 8) compared to nylon (2.4 %, n = 2). Multivariable logistic regression showed that inflammatory arthritis, immunosuppressant drug use, and junior resident assistance were independent predictors of wound complications.

Conclusion

In conclusion, we found usage of Monocryl sutures following carpal tunnel and trigger finger release associated with higher a dehiscence rate within 90 days post-operation. Additionally, factors including resident training level, immunosuppression, and inflammatory arthritis were associated with increased complications.

Type of Study/Level of Evidence

Therapeutic IV