CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2318-1287
Pediatric/Craniomaxillofacial/Head & Neck: Review Article

Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes

1   Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
7   Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
,
Sophie Bondje*
2   Department of ENT Surgery & Cancer Services, Torbay Hospital, Torquay, United Kingdom
,
3   Urology Division, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
,
4   Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
5   Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
,
6   Department of Surgery & Cancer, Imperial College London, London, United Kingdom
› Author Affiliations
Funding None.

Abstract

When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and nonabsorbable sutures for facial skin closure.

The study was registered on Prospective Register of Systematic Reviews. We conducted searches on Embase, Ovid, and PubMed/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool.

The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while nonabsorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and nonabsorbable sutures regarding infections (p = 0.72), visual analog scale (p = 0.69), wound dehiscence (p = 0.08), and scarring (p = 0.46). The quality of the included studies was determined to have a low risk of bias.

Absorbable sutures can be considered a suitable alternative to nonabsorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician–patient shared decision-making and optimize the selection of suture materials.

Level of evidence is I, risk/prognostic study.

Authors' Contributions

K.M.: Conceptualization, methodology, writing—original draft, writing—review and editing.

S.B.: Data curation, writing—review and editing.

A.S.: Investigation, validation, visualization. writing.

H.M.: Original Draft, Writing, Editing, formal analysis.

A.K.: Funding acquisition, writing—review and editing.


Ethical Approval

This study was performed in-line with the principles of the Declaration of Helsinki. Approval was granted was waived due to the nature of the study.


Patient Consent

Not applicable.


* These authors contributed equally and are joint first authors.




Publication History

Received: 05 June 2023

Accepted: 15 April 2024

Accepted Manuscript online:
02 May 2024

Article published online:
19 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res 2010; 89 (03) 219-229
  • 2 Braun TL, Maricevich RS. Soft tissue management in facial trauma. Semin Plast Surg 2017; 31 (02) 73-79
  • 3 Rose J, Tuma F. Sutures and Needles. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. . Accessed September 1, 2022 at: https://www.ncbi.nlm.nih.gov/books/NBK539891/
  • 4 Fowler JR, Perkins TA, Buttaro BA, Truant AL. Bacteria adhere less to barbed monofilament than braided sutures in a contaminated wound model. Clin Orthop Relat Res 2013; 471 (02) 665-671
  • 5 Moy RL, Waldman B, Hein DW. A review of sutures and suturing techniques. J Dermatol Surg Oncol 1992; 18 (09) 785-795
  • 6 Fein JA, Zempsky WT, Cravero JP. Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012; 130 (05) e1391-e1405
  • 7 Wade RG, Wormald JC, Figus A. Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. Cochrane Database Syst Rev 2018; 2 (02) CD011757
  • 8 Gillanders SL, Anderson S, Mellon L, Heskin L. A systematic review and meta-analysis: do absorbable or non-absorbable suture materials differ in cosmetic outcomes in patients requiring primary closure of facial wounds?. J Plast Reconstr Aesthet Surg 2018; 71 (12) 1682-1692
  • 9 Al-Mubarak L, Al-Haddab M. Cutaneous wound closure materials: an overview and update. J Cutan Aesthet Surg 2013; 6 (04) 178-188
  • 10 Fosko SW, Heap D. Surgical pearl: an economical means of skin closure with absorbable suture. J Am Acad Dermatol 1998; 39 (2 Pt 1): 248-250
  • 11 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269 , W64
  • 12 Cumpston M, Li T, Page MJ. et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10 (10) ED000142
  • 13 Schiavo JH. PROSPERO: An international register of systematic review protocols. Med Ref Serv Q 2019; 38 (02) 171-180
  • 14 Higgins JP, Altman DG, Gøtzsche PC. et al; Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
  • 15 Sullivan D, Chung KC, Eaves III FF, Rohrich RJ. The level of evidence pyramid: indicating levels of evidence in Plastic and Reconstructive Surgery articles. Plast Reconstr Surg 2011; 128 (01) 311-314
  • 16 Parell GJ, Becker GD. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds. Arch Facial Plast Surg 2003; 5 (06) 488-490
  • 17 Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med 2004; 11 (07) 730-735
  • 18 Holger JS, Wandersee SC, Hale DB. Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable, and nonabsorbable sutures. Am J Emerg Med 2004; 22 (04) 254-257
  • 19 Rosenzweig LB, Abdelmalek M, Ho J, Hruza GJ. Equal cosmetic outcomes with 5-0 poliglecaprone-25 versus 6-0 polypropylene for superficial closures. Dermatol Surg 2010; 36 (07) 1126-1129
  • 20 Luck R, Tredway T, Gerard J, Eyal D, Krug L, Flood R. Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care 2013; 29 (06) 691-695
  • 21 Eisen DB, Zhuang AR, Hasan A, Sharon VR, Bang H, Crispin MK. 5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial. Arch Dermatol Res 2020; 312 (03) 179-185
  • 22 Erol O, Buyuklu F, Koycu A, Jafarov S, Gultekin G, Erbek SS. Comparison of rapid absorbable sutures with nonabsorbable sutures in closing transcolumellar incision in septorhinoplasty: short-term outcomes. Aesthetic Plast Surg 2020; 44 (05) 1759-1765
  • 23 Moran B, Humphrey S, Seal A, Berkowitz J, Zloty D. Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: a randomized clinical trial. J Am Acad Dermatol 2020; 83 (05) 1395-1399
  • 24 Luck RP, Flood R, Eyal D, Saludades J, Hayes C, Gaughan J. Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care 2008; 24 (03) 137-142
  • 25 Sajid MS, McFall MR, Whitehouse PA, Sains PS. Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions. World J Gastrointest Surg 2014; 6 (12) 241-247
  • 26 Xu B, Xu B, Wang L. et al. Absorbable versus nonabsorbable sutures for skin closure: a meta-analysis of randomized controlled trials. Ann Plast Surg 2016; 76 (05) 598-606