Locking vs Standard Sutures for Surgical Wounds

Recruiting in Palo Alto (17 mi)

Overseen by Daniel Eisen, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of California, Davis

Disqualifiers: Incarceration, Under 18, Pregnant, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

When patients have surgery on the head and face, stitches are the standard way to close the wound. Wounds always result in a scar, but doctors are always looking for ways to reduce scarring. Several studies have been done to test ways to close wounds that reduce scarring. The most commonly performed closure technique uses running sutures, where a single strand of suture is continued along the length of the wound with a series of uninterrupted stiches. However, alternative closure techniques exist such as the running locking suture, which can offer advantages such as improved tension and thus reduce post-operative complications with better aesthetic outcome. In this study, half the wound will be stitched with standard running sutures and the other half will be stitched with running locking sutures. This will allow us to see if the side with running locking sutures heals with less scarring.

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the treatment Locking vs Standard Sutures for Surgical Wounds?

Research shows that various running suture techniques, like the running locked intradermal suture, offer good cosmetic results, reduce infection risk, and minimize postoperative care. These techniques are effective for closing wounds under light tension and provide benefits like ease of removal and wound edge eversion. ^{1 2 3 4 5}

Is the use of locking or standard sutures for surgical wounds generally safe in humans?

Research indicates that continuous running sutures, including locking types, are generally safe for wound closure in humans. They can reduce the risk of wound infection, provide good cosmetic results, and are as safe as traditional methods in various surgical procedures. ^{1 2 3 6 7}

How does the treatment of locking vs standard sutures for surgical wounds differ from other treatments?

The locking suture technique is unique because it provides a continuous, buried suture that reduces the space between skin layers, leading to better cosmetic results and less need for postoperative care. Unlike standard sutures, it minimizes the risk of infection and does not require removal, making it a more convenient option for patients. ^{1 2 3 8 9}

Eligibility Criteria

This trial is for patients undergoing surgery on the head and face. It's designed to compare scarring outcomes between two stitching techniques: standard running sutures versus running locking sutures. Participants must be eligible for this type of surgical procedure.

Inclusion Criteria

Willing to return for follow up visit

Able to give informed consent themselves

I am 18 years old or older.

Exclusion Criteria

Incarceration

Pregnant Women

My wound is expected to close and is less than 3cm long.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo surgical wound closure using either running locking sutures or standard running sutures in a split-wound model

Immediate post-surgery

1 visit (in-person)

Follow-up

Participants are monitored for scar width, complications, and scar assessment using POSAS over a period of 3 months

3 months

Multiple visits (in-person)

Treatment Details

Interventions

• Running locking suture (Procedure)
• Standard running suture (Procedure)

Trial Overview The study is testing if a different way of stitching called 'running locking suture' can reduce scarring compared to the usual 'standard running suture'. Each patient's wound will be half-closed with each method to directly compare results on the same person.

Participant Groups

Group I: Layered Closure with Running Locking Suture on Side B Experimental Treatment 2 Interventions

For all participants, one wound side half will be labeled as A and the other side as B. The bottom (subcutaneous) layer of the entire wound will receive the normal stitching. For the upper (cutaneous) layer, Side B will be closed with a running locking suture, and Side A will be closed with a standard running suture.

Group II: Layered Closure with Running Locking Suture on Side A Experimental Treatment 2 Interventions

For all participants, one wound side half will be labeled as A and the other side as B. The bottom (subcutaneous) layer of the entire wound will receive the normal stitching. For the upper (cutaneous) layer, Side A will be closed with a running locking suture, and Side B will be closed with a standard running suture.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

University of California, Davis - Dermatology Department Sacramento, CA

Who Is Running the Clinical Trial?

University of California, Davis Lead Sponsor

References

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

Running vertical mattress suture. [2019] Various types of running sutures have been described for use in dermatologic surgery. The running vertical mattress suture is a time-saving technique that can be used alone or in combination with any running-suture technique. It is useful for wound eversion, providing hemostasis, and closing wounds under mild tension.

2. Australia pubmed.ncbi.nlm.nih.gov

The recovery suture. [2019] Continuous running sutures have several advantages in wound closure but can be difficult to remove. A loop tied around an exposed section of the running suture or an adjacent interrupted suture allows visualization and ease of removal.

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

The running locked intradermal suture. A cosmetically elegant continuous suture for wounds under light tension. [2019] A new suture technique, the running locked intradermal suture, is introduced. The suture is continuous and buried, and is designed for closing simple elliptical wounds under light tension in which a good cosmetic result is desired. It is used in conjunction with a topical antibiotic and a transparent dressing. This technique reduces the dermal dead space, achieves close approximation of the epidermal wound edges, has a good cosmetic appearance soon after surgery, reduces necessary postoperative wound care, reduces the risk of wound infection in clean surgical wounds, and obviates suture removal. Three examples of its application on the face are presented. It is compared with frequently used standard wound closure methods are discussed.

4. India pubmed.ncbi.nlm.nih.gov

Horizontal running mattress suture modified with intermittent simple loops. [2021] Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.

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

Running vertical mattress suturing technique. [2019] The running vertical mattress suturing technique is a quick and simple method of providing skin edge eversion that is equivalent to the simple vertical mattress technique. The running stitch is relatively easy to master and provides excellent apposition of wound edges.

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

Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. [2022] In midline incisions closed with a single-layer running suture, the rate of wound complications is lower when a suture length to wound length ratio of at least 4 is accomplished with a short stitch length rather than with a long one.

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

Wound healing after open appendectomies in adult patients: a prospective, randomised trial comparing two methods of wound closure. [2021] The skin is closed in open appendectomy traditionally with few interrupted nonabsorbable sutures. The use of this old method is based on a suggestion that this technique decreases wound infections. In pediatric surgery, skin closure with running intradermal absorbable sutures has been found to be as safe as nonabsorbable sutures, even in complicated cases. Our purpose was to compare the safety of classic interrupted nonabsorbable skin closure to continuous intradermal absorbable sutures in appendectomy wounds in adult patients.

8. Czech Republic pubmed.ncbi.nlm.nih.gov

[Surgical wound closure with continuous sutures]. [2016] The author describes the technique of closure of surgical wounds by continuous suture. It is a vertical mattress suture, as described by Donatti-Mc Millen, which is made continuously along the whole wound. It may involve either one layer, depending on the depth of the wound, or it can be used after the usual treatment of the subcutaneous layer. For suture monophil fibre with atraumatic threading is optimal but any other material can be used for suture. The advantage is the simple and rapid character of the procedure, adequate haemostasis and perfect adaptation of the margins of the wound. A balanced tension of the fibre in the whole wound reduces the risk of ischaemisation of a single stitch. The stitch can be readily removed, and if properly done, the cosmetic effect is satisfactory. The economy of material is not negligible either. The authors have used it as a matter of routine since 1984.

9. Netherlands pubmed.ncbi.nlm.nih.gov

Torsion of monofilament and polyfilament sutures under tension decreases suture strength and increases risk of suture fracture. [2012] A continuous running suture is the preferential method for abdominal closure. In this technique the suture is secured with an initial knot and successive tissue bites are taken. At each tissue bite, the needle is rotated through the tissue; in doing so, the suture can twist around the knot which acts as an anchor.