Comparison of two skin closure techniques in open carpal tunnel release: a randomized controlled trial on postoperative pillar pain and scar quality.

Background: Pillar pain and scar-related discomfort are common complications following open carpal tunnel release (CTR). While surgical approaches have been widely studied, the influence of skin closure techniques on postoperative pillar pain remains unclear. This study aimed to compare the effect of two different skin closure methods, subcuticular absorbable monocryl sutures versus interrupted non-absorbable nylon sutures, on postoperative pillar pain and scar quality.

Methods: In this randomized controlled trial, 128 patients who underwent open carpal tunnel release by a single surgeon were randomly assigned to one of the two groups using a computer-generated randomization sequence. Group 1 received subcuticular monocryl closure, while Group 2 received interrupted nylon sutures. Patients were evaluated at 2, 6, and 12 weeks postoperatively using the Visual Analog Scale (VAS) for pillar pain and the Patient and Observer Scar Assessment Scale (POSAS) for scar evaluation.

Results: Patients in the monocryl group reported significantly lower VAS scores for pillar pain at 6 weeks (P < 0.05), with differences narrowing by week 12. POSAS scores also favored monocryl at early follow-up, particularly in parameters such as itching and stiffness. No major complications were observed in either group.

Conclusion: Skin closure techniques may significantly affect early postoperative outcomes in CTR. Subcuticular monocryl sutures were associated with reduced pillar pain and improved scar quality in the early recovery phase, suggesting their potential advantage over conventional nylon sutures.