Suture Types for Carpal Tunnel and Trigger Finger Surgery

Recruiting in Palo Alto (17 mi)

Overseen by Peter C Rhee, DO, MS

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Mayo Clinic

Disqualifiers: Revision surgery, Prior surgery, Dupuytren's, others

No Placebo Group

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

Does a difference in patient satisfaction and cosmetic outcome exist between wound closure with absorbable or non-absorbable sutures.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of different suture types for wound closure in carpal tunnel and trigger finger surgery?

Research shows that using Monocryl sutures for wound closure in carpal tunnel and trigger finger surgeries results in fewer complications like wound dehiscence (wound reopening) and infections compared to nylon and chromic sutures. However, there is no significant difference in overall outcomes between absorbable and non-absorbable sutures in these surgeries. ^{1 2 3 4 5}

Are sutures safe for carpal tunnel and trigger finger surgery?

Sutures are generally safe for carpal tunnel and trigger finger surgeries, but the type of suture can affect the risk of complications. Monocryl sutures showed lower rates of wound problems like infection and reopening compared to nylon and chromic gut sutures. Absorbable sutures may lead to more wound complaints but have similar overall outcomes to non-absorbable sutures. ^{1 2 3 4 6}

How does the treatment of wound closure with different suture types for carpal tunnel and trigger finger surgery differ from other treatments?

The treatment of wound closure using different suture types, such as absorbable and non-absorbable sutures, is unique because it focuses on the method of closing the surgical incision rather than the surgery itself. This approach aims to reduce complications like wound dehiscence (reopening of the wound) and infection, with some studies suggesting that certain sutures like Monocryl may lead to better outcomes compared to others like nylon or chromic gut. ^{1 2 4 5 6}

Eligibility Criteria

This trial is for adults 18 years or older who are having their first carpal tunnel release or trigger finger pulley release surgery. It's not for those who've had previous surgeries on the same hand or have Dupuytren's disease.

Inclusion Criteria

You recently had surgery for carpal tunnel or trigger finger.

You are 18 years old or older.

Exclusion Criteria

Patient identified outside of the proposed study time period

You have had a previous surgery to fix a problem.

You have had surgery on the same hand or fingers before.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to wound closure with either absorbable or non-absorbable sutures

1-2 weeks

Follow-up

Participants are monitored for scar formation and cosmetic outcomes using POSAS and PRWHE

1 year

Treatment Details

Interventions

• Wound closure (Procedure)

Trial Overview The study is testing whether there's a difference in patient satisfaction and how scars look when using absorbable versus non-absorbable stitches after surgery for carpal tunnel syndrome or trigger finger.

Participant Groups

Group I: Absorbable suture Experimental Treatment 1 Intervention

Wound closure with absorbable suture.

Group II: Non-absorbable suture Active Control 1 Intervention

Wound closure with non-absorbable suture.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

Mayo Clinic in Rochester Rochester, MN

Who Is Running the Clinical Trial?

Mayo Clinic Lead Sponsor

References

1. United States pubmed.ncbi.nlm.nih.gov

Clinical outcome and wound healing following carpal tunnel decompression: a comparison of two common suture materials. [2021] Debate exists amongst surgeons regarding the ideal suture material for skin closure in carpal tunnel decompression (CTD). This study compares wound related complications, patient satisfaction, and functional outcome following open carpal tunnel decompression in patients undergoing wound closure with either of two common absorbable and nonabsorbable suture types.

2. Scotland pubmed.ncbi.nlm.nih.gov

Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release. [2009] A prospective randomized trial was undertaken to compare the influence of absorbable and non-absorbable sutures on pillar pain, scar tenderness, extent of wound inflammation and overall outcome of the surgery following open carpal tunnel release. Forty hands in 33 patients (mean age, 51 years; range, 31-74 years) were randomized into group A (absorbable sutures) or group B (non-absorbable sutures). Clinical assessment was done at 2, 6 and 12 weeks follow-up. The outcome of surgery in terms of improvement of severity of symptoms and functional status of patients was assessed using a self-administered Boston Questionnaire. There was no significant difference between the two groups for any of our outcome measures at the final follow-up.

3. United States pubmed.ncbi.nlm.nih.gov

Absorbable Sutures and Telemedicine for Patients Undergoing Trigger Finger Release. [2023] Background In the setting of the COVID-19 pandemic, the development of care processes that reduce the need for in-person clinic visits while maintaining low complication rates is needed. The purpose of this study is to assess the outcomes of patients undergoing trigger finger release with various suture and follow-up visit types to assess the feasibility of shifting towards telemedicine-based follow-up protocols. Methods A retrospective review of 329 patients undergoing trigger finger release was performed. Patients were classified based on whether or not they received in-office follow-ups; whether they received absorbable or non-absorbable sutures; and whether they were treated using a telemedicine and absorbable suture protocol or other combination of sutures and follow-ups. Univariate statistics were performed to compare outcomes between groups. Results Patients who did not undergo in-office follow-up were more likely to experience residual stiffness or contracture (11.4% vs. 4.1%; p=0.033) but had no significant differences in 30-day reoperation, emergency department (ED) returns, wound complaints, and Quick DASH (Disabilities of the Arm, Shoulder, and Hand) scores. When comparing chromic absorbable sutures to non-absorbable sutures, those with absorbable sutures were significantly more likely to have telemedicine visits but were also more likely to have wound complaints (17.9% vs. 8.5%; p=0.022). There was no significant difference in two- and six-week pain scores, 30-day reoperation, ED returns, residual symptoms, and Quick DASH scores. When comparing patients treated using the absorbable suture and telemedicine protocol with those receiving any other type of suture and postoperative follow-up, no significant differences in any postoperative clinical outcome measures were observed. Conclusion The results of this study demonstrate that the use of an absorbable suture and telemedicine protocol for patients undergoing trigger finger release yields similar outcomes as traditional methods of care. However, the use of absorbable sutures may result in decreased patient satisfaction with surgical wound healing.

4. United States pubmed.ncbi.nlm.nih.gov

Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery. [2020] There is currently no consensus on the optimal suture type for palmar skin closure following open carpal tunnel release and trigger finger release. We performed a retrospective analysis of patients in the Palo Alto Veterans Affairs (PAVA) Health Care System who underwent these procedures over a 2-year period to compare 30-day wound outcomes following closure with poliglecaprone 25 (Monocryl), nylon, and chromic gut suture. Out of 312 PAVA cases (133 carpal tunnel release, 179 trigger finger release), incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012). On multivariable logistic regression, suture type and diabetes were independent predictors of 30-day wound complications and extra encounters. At PAVA, compared with Monocryl, closures with nylon and chromic were significantly more likely to dehisce and/or become infected [nylon: odds ratio (OR), 5.0; 95% CI, 1.9-13.3 and chromic: OR, 9.3; 95% CI, 2.7-32.4; P = 0.002], and to be associated with an additional encounter (nylon: OR, 2.4; 95% CI, 1.1-5.3 and chromic: OR, 4.5; 95% CI, 1.6-12.9; P = 0.007). This has led to using Monocryl as the standard closure for these cases at PAVA.

5. England pubmed.ncbi.nlm.nih.gov

Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. [2022] Carpal tunnel syndrome is a common problem and surgical decompression of the carpal tunnel is the most effective treatment. After surgical decompression, the palmar skin may be closed using either absorbable or non-absorbable sutures. To date, there is conflicting evidence regarding the ideal suture material and this formed the rationale for our review.

6. United States pubmed.ncbi.nlm.nih.gov

Including a Vessel Loop in Wound Closure Facilitates Suture Removal Following Open Carpal Tunnel Release. [2023] Many hand surgeons prefer to close palmar wounds with non-absorbable mattress sutures. Suture removal can be painful and time-consuming. In this study, we investigated if suture removal can be facilitated by including a vessel loop in wound closure following open carpal tunnel release (CTR).