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Scar Satisfaction: Do Nylon or Monocryl Sutures Fare Better for Orthopedic Wound Closure?
Julianne W. Gillis, MD, Krishna N. Chopra, MA, Joanne Y. Zhou, MD, Victoria A. Conn, BS, Frank L. Vazquez, BSAT, Sarah M. Taub, PA-C, Amanda L. Dempsey, MD, Nina Suh, MD, Paul A. Ghareeb, MD, Michael B. Gottschalk, MD; Eric R. Wagner, MD, MS
Emory University School of Medicine, Atlanta, GA
Introduction: This study evaluates short-term patient-reported and observer-reported outcomes for carpal tunnel release (CTR) and trigger finger release (TFR) incisions closed with absorbable Monocryl or non-absorbable nylon sutures. We hypothesized that patients' scar satisfaction would be higher for incisions closed with Monocryl.
Materials & Methods: Patients undergoing primary TFR or CTR were approached for inclusion in this randomized controlled trial and were randomly assigned to receive nylon (control) or Monocryl (treatment) as their suture closure material. VAS pain was the primary outcome, while scar color, thickness, stiffness, and irregularity (subjective), as well as vascularity, pigmentation, thickness, relief, and surface area (objective) were secondary outcomes. Participants were asked to respond to secondary outcome measures at 6 weeks and 3 months postoperatively. Photos were taken by study assessors during each of these visits. Two blinded observers then separately rated objective outcomes using the photos.
Results: 160 participants were enrolled in this study - 79 were closed with Monocryl, and 81 were closed with nylon. After 6 weeks, there were no significant differences in primary or secondary outcomes between groups. Participants closed with nylon reported more noticeable scars than those closed with Monocryl, but overall scar opinions were not significantly different. After 3 months, VAS pain did not significantly differ between nylon and Monocryl. While participants across both groups reported similar secondary outcomes, participants closed with Monocryl reported higher overall opinions of their scars compared to those closed with nylon. There were no differences in scar ratings at either postoperative timepoint between participants who underwent CTR versus TFR.
When looking at observer scar ratings, there were no significant differences at 6 weeks postoperatively. At 3 months postoperatively, Observer 1 rated Monocryl scars as more like normal skin. While Observer 2 also had a better overall opinion of Monocryl scars, this difference was not statistically significant. When looking at individual scar categories at 3 months postoperatively, both observers noted nylon scars as thicker and more irregular.
Discussion: Patients closed with Monocryl reported significantly higher overall satisfaction with scar appearance at 3 months postoperatively compared to those closed with nylon. Blinded observers rated incisions closed with Monocryl more favorably, both overall and across specific parameters such as thickness and irregularity. Future research could build on these results by evaluating a broader range of absorbable and non-absorbable suture types, incorporating larger sample sizes, and employing additional blinded observers to enhance the objectivity of scar assessments.
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