- Email: [email protected]
Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews
Accepted Manuscript Title: Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews Authors: Sharaf Sheik-Ali, Wilfried Guets PII: DOI: Reference:
S2213-9095(18)30047-8 https://doi.org/10.1016/j.wndm.2018.09.004 WNDM 138
To appear in: Received date: Accepted date:
10-8-2018 13-9-2018
Please cite this article as: Sheik-Ali S, Guets W, Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews, Wound Medicine (2018), https://doi.org/10.1016/j.wndm.2018.09.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1.
Authors: Mr Sharaf Sheik-Ali1 , Mr Wilfried Guets 2
2.
Mr Sharaf Sheik-Ali (FIRST AUTHOR AND CORRESPONDING AUTHOR) i. Barts and the London School of Medicine and dentistry ii. Email: [email protected] Mr Wilfried Guets i. university of Lyon - Gate L-SE; Leon Berard Hospital
U
SC R
3.
IP T
Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews
Abstract
A
N
Objective: To provide an overview of evidence on Absorbable and non-absorbable sutures (AS & NAS) for the closure of surgical incisions
ED
M
Methods: Medline, Embase and Cochrane library were searched for systematic reviews including randomised control trials (RCTs) on AS and NAS. Those that matched the inclusion criterion were analysed for data on surgical site infections, post operative complications and risk of wound dehiscence.
PT
Results: The systematic review of reviews yielded data on 5781 patients in 25 RCTs. There was no significant difference (p<0.05) noted in surgical site infections, post operative complications or risk of wound dehiscence post use of NAS or AS sutures.
A
CC E
Conclusion: This study demonstrates that absorbable sutures are not superior to non absorbable sutures in the three areas examined: surgical site infections, post operative complications and risk of wound dehiscence. However, there was significant heterogeneity between included RCTs in the systematic reviews. Further RCTs are needed to evaluate the differences between absorbable and non absorbable sutures that are reflected in size of wounds and location.
Keywords: Wound, infection, sutures
Introduction
There have been a significant number of studies that allude to the benefits of absorbable or nonabsorbable suturing techniques. Arguments both for and against each technique have been previously published (Kundra et al. 2010, Morritt 2011, Wade, Wormald and Figus 2018). Absorbable sutures most notably require less medical attention post op. Non absorbable sutures have been suggested to provide more tensile strength resulting in margins of incisions being in improved proximity resulting in improved wound healing time (Selvi et al. 2016). Important comparisons made between AS and NAS include post op infections, complications and
IP T
wound healing. A recent systematic review demonstrated no significant difference between NAS and
AS in healing post skin incisions, however there have been previous studies that have recorded
differing results (Sajid et al. 2014, Al-Mubarak and Al-Haddab 2013). With the ever increasing
SC R
number of systematic reviews collating data on AS and NAS, this study reviews relevant systematic reviews on NAS and AS in surgical closure of wounds.
U
Methods:
N
Medline, Embase and Cochrane library were used to find systematic reviews and meta analyses
A
comparing absorbable vs non absorbable sutures in surgical wound closure. This was defined broadly as all surgeries that required stitching of a wound post op. Studies were searched from the origin of
M
data bases until now.
MeSH search words included “absorbable sutures” “non-absorbable sutures” “surgery” “surgical
ED
incisions” “wound”. No limitations were placed such as size of study or linguistics. Chosen studies were scrutinised and data extracted by all authors. Bibliographies were further scrutinised and further
PT
papers extracted.
No methodological checklist grid (measurement tool/instrumentused to assess reviews) was used to
CC E
assess full-texts of relevant abstract selected. Study selection: Systematic reviews comparing AS to NAS involving any type of surgical wound closure.
A
Data extraction:
Two authors extracted the data from the selected papers individually then combined their results. Any differences were further discussed and advice sort from a third party.
Results
According to our research strategy, we identified N=25 abstract (10+15) of whichN=14 were duplicates and were removed. After duplicates removed, 11 records were identified for full-text assessment. Of these records, N=3 reviews were included in this systematic review of systematic reviews on AS and NAS. The systematic reviews (SRs) used were extracted from Medline, Embase, and Cochrane library database, on which we extracted details on sutures for wound closure, complications post op and infection rates. Figure 1 displays the PRISMA flowchart of the research
A
CC E
PT
ED
M
A
N
U
SC R
IP T
strategy and the screening process.
Figure 1 :Studies screeningprocess
Additional records identified through other sources (n = 10 )
A
N
Records screened (n =11 )
U
Screening
Records after duplicates removed (n =11 )
ED PT CC E
A
Included
Eligibility
M
Full-text articles assessed for eligibility (n =4 )
Studies included in qualitative synthesis (n = 3 )
IP T
Records identified through database searching (n =15 )
SC R
Identification
PRISMA 2009 Flow Diagram
Records excluded (n = 7 )
Full-text articles excluded, with reasons (n =1 )
Used both absorbable and non absorbable sutures on the same population group.
Studies included in quantitative synthesis (meta-analysis) (n =3 )
The table 1 illustrates the basic characteristics of the included SRs.For each intervention, we reported details on the following: (1) surgical site infections; (2) post op complications; (3) risk of wound dehiscence.
I N U SC R
Table 1:
Year Aim (Total no. of participants )
To complete a systematic review of randomized controlled trials (RCTs) that compare the cosmetic outcomes and complications of 2007 traumatic lacerations and surgical incisions closed with absorbable sutures versus nonabsorbable sutures (44 to 166 patients) To systematically analyse the effectiveness of delayedabsorbable (Polydioxanone; PDS) versus non-absorbable 2011 (Polypropylene; Prolene, and Nylon) for abdominal fascial closure in patients undergoing laparotomy (4261 patients) To report a systematic review of published randomized controlled trials (RCTs) investigating the role of 2014 absorbable suture (AS) against non-AS (NAS) used for the closure of surgical incisions (1354 patients)
Searchstrategy
No. of studiesincluded
Surgical site infections
7
OR of 1.00 (95% CI, 0.39– 2.56); Traumatic lacerationsOR of 0.42 (95% CI, 0.07 to 2.51).
8
OR, 0.98; 95% OR, 0.94; 95% CI, 0.68, 1.39; CI, 0.66, 1.33; z = z = 0.14; p = 0.37; p = 0.71 0.89
OR, 1.04; 95% CI, 0.67, 1.62; z = 0.19; p = 0.85
10
OR = 0.97; 95%CI: 0.56, N/A 1.69; Z = 0.11; P = 0.92
OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).
A
CC E
Sajid et al
PT
ED
Al-Abdullah et al
M
A
Author
Sajid et al
MEDLINE, EMBASE, Cochrane Central
Cochrane Colorectal Cancer Group (CCCG) Controlled Trial Register, Cochrane Central Register of controlled Trials (CENTRAL), Medline, Embase and Science Citation Index
MEDLINE, EMBASE, and Cochrane library
Post operative complications
Risk of wounddehiscence
redness at wound site after suturing: OR of 0.44 (95% CI, 0.09–2.32) OR of 0.16 (95% Swelling or CI, 0.02 to 1.45) edema at the site of suture with an OR of 1.18 (95% CI, 0.50–2.80).
I N U SC R
Quality analysis (Table 2)
A
AMSTAR CHECKLIST
A
CC E
PT
ED
M
Category Was an "a priori" design provided Was there duplicate study selection and data extraction Was a comprehensive literature search performed? Was the status of publication (i.e. grey literature) used as an inclusion criterion? Was a list of studies (included and excluded) provided? Were the characteristics of the included studies provided? Was the scientific quality of the included studies used appropriately in formulating conclusions? Were the methods used to combine the findings of studies approriate? Was the likelihood of publication bias assessed? Was the conflicit of interest stated?
Al-Abdullah et al 2007
Sajid et al 2011
Sajid et al 2014
Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Yes Yes Yes No Yes n/a Yes Yes No Yes
Yes Yes Yes No Yes Yes Yes Yes No Yes
Discussion 5781 cases of surgical wound closure were analysed. There was no significant difference noted in surgical site infections, post operative complications or risk of wound dehiscence post op. The findings of this review demonstrate that both absorbable andnon absorbable sutures are equally favourable for surgical wound closure. The conclusions of this study are consistent with previous studies. A study examining the cost
IP T
difference in cost between non-dissolving sutures, dissolving sutures and tissue adhesive noted that tissue adhesive was of more economic value and preferred by patients. However the study had a
significant small sample size and the study population was paediatric patients (Osmond, Klassen and
SC R
Quinn 1995).
The systematic reviews included studies that had significant differences in the inclusion criteria. RCTs of differing patient groups were included, including plastics, general surgery and orthopaedics
U
resulting in significant heterogeneity between the studies.
Al-Abdullah et al 2007 conducted a literature search of randomised control trials of which 7 met their
N
inclusion criteria (Al-Abdullah, Plint Ac Fau - Fergusson and Fergusson). It noted significant
A
heterogeneity between studies which could implicate their overall conclusion. Furthermore included studies had a range of sample sizes from 44 to 166, which is proven to be critical for clinical
M
application (Suresh and Chandrashekara 2012).
ED
Sajid et al 2011 included 8 RCT studies, subtotalling 4261 patients. The authors compared slow absorbable to non absorbable sutures. Although this may differ from the other two studies included in this systematic review of systematic reviews, it is valid as the population groups included were
PT
compared on factors of our studies interest and continued with the same suture throughout the trials (Sajid et al. 2011).
CC E
Sajid et al 2014 simillarly conducted a systematic review comparing NAS to AS on a range of aspects. The authors noted substantial variations in operations that were performed inlcuding orthopaedic and plastic and thus caution must be taken when interpreting the results (Sajid et al.
A
2014).
Definitions on infection of wounds, wound types, wound dehiscence and post operative complications varied. Sufficient information was not recorded on wound location or cosmetic outcomes. Improper concealment of allocation to both group and use of different absorbable sutures in some studies further impacts the quality of the systematic reviews. Furthermore only 3 systematic reviews were found to suit the inclusion criteria. Furthermore patient expectations on outcomes were not recorded, which has shown to effect overall outcome (Waljee et al. 2014).
Although the systematic reviews were of high standard (AMSTAR checklist table 2), the authors acknowledge the significant variations in study design and methodologies of included RCT’s. Due to such variants, a number of multi centre randomised control trials are needed to establish a systematic review with less heterogeneity. Almost all studies compared the two options via continuous stitch, thus it is hard to reach a conclusion if the type of stitching can affect the results.
IP T
Conclusion This study demonstrates that absorbable sutures are not superior to non absorbable sutures in the three areas examined: surgical site infections, post operative complications and risk of wound dehiscence.
SC R
However, there was significant heterogeneity between included RCTs in the systematic reviews.
Further RCTs are needed to evaluate the differences between absorbable and non absorbable sutures
U
that are reflected in size of wounds and location.
N
All authors declare no conflict of interest. Finance: No financial input.
CC E
References
M
PT
ED
All authors declare no ethical issues.
A
Ethics: Review article
A
1. Al-Abdullah, T., D. Plint Ac Fau - Fergusson & D. Fergusson Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. 2. Al-Mubarak, L. & M. Al-Haddab (2013) Cutaneous Wound Closure Materials: An Overview and Update. Journal of Cutaneous and Aesthetic Surgery, 6, 178-188. 3. Kundra, R. K., S. Newman, A. Saithna, A. C. Lewis, S. Srinivasan & K. Srinivasan (2010) Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery. Annals of The Royal College of Surgeons of England, 92, 665-667. 4. Morritt, A. N. (2011) Absorbable or non-absorbable sutures? Annals of The Royal College of Surgeons of England, 93, 183-183. 5. Osmond, M. H., T. P. Klassen & J. V. Quinn (1995) Economic comparison of a tissue adhesive and suturing in the repair of pediatric facial lacerations. J Pediatr, 126, 892-5.
A
CC E
PT
ED
M
A
N
U
SC R
IP T
6. Sajid, M. S., M. R. McFall, P. A. Whitehouse & P. S. Sains (2014) Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions. World Journal of Gastrointestinal Surgery, 6, 241-247. 7. Sajid, M. S., U. Parampalli, M. K. Baig & M. R. McFall (2011) A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg, 9, 615-25. 8. Selvi, F., S. Cakarer, T. Can, S. İ. Kirli Topcu, A. Palancioglu, B. Keskin, B. Bilgic, M. Yaltirik & C. Keskin (2016) Effects of different suture materials on tissue healing. Journal of Istanbul University Faculty of Dentistry, 50, 35-42. 9. Suresh, K. P. & S. Chandrashekara (2012) Sample size estimation and power analysis for clinical research studies. Journal of Human Reproductive Sciences, 5, 7-13. 10. Wade, R. G., J. C. Wormald & A. Figus (2018) Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. Cochrane Database Syst Rev, 2, CD011757. 11. Waljee, J., E. P. McGlinn, E. D. Sears & K. C. Chung (2014) Patient Expectations and PatientReported Outcomes in Surgery: A Systematic Review. Surgery, 155, 799-808.
S2213-9095(18)30047-8 https://doi.org/10.1016/j.wndm.2018.09.004 WNDM 138
To appear in: Received date: Accepted date:
10-8-2018 13-9-2018
Please cite this article as: Sheik-Ali S, Guets W, Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews, Wound Medicine (2018), https://doi.org/10.1016/j.wndm.2018.09.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1.
Authors: Mr Sharaf Sheik-Ali1 , Mr Wilfried Guets 2
2.
Mr Sharaf Sheik-Ali (FIRST AUTHOR AND CORRESPONDING AUTHOR) i. Barts and the London School of Medicine and dentistry ii. Email: [email protected] Mr Wilfried Guets i. university of Lyon - Gate L-SE; Leon Berard Hospital
U
SC R
3.
IP T
Absorbable vs non absorbable sutures for wound closure. Systematic review of systematic reviews
Abstract
A
N
Objective: To provide an overview of evidence on Absorbable and non-absorbable sutures (AS & NAS) for the closure of surgical incisions
ED
M
Methods: Medline, Embase and Cochrane library were searched for systematic reviews including randomised control trials (RCTs) on AS and NAS. Those that matched the inclusion criterion were analysed for data on surgical site infections, post operative complications and risk of wound dehiscence.
PT
Results: The systematic review of reviews yielded data on 5781 patients in 25 RCTs. There was no significant difference (p<0.05) noted in surgical site infections, post operative complications or risk of wound dehiscence post use of NAS or AS sutures.
A
CC E
Conclusion: This study demonstrates that absorbable sutures are not superior to non absorbable sutures in the three areas examined: surgical site infections, post operative complications and risk of wound dehiscence. However, there was significant heterogeneity between included RCTs in the systematic reviews. Further RCTs are needed to evaluate the differences between absorbable and non absorbable sutures that are reflected in size of wounds and location.
Keywords: Wound, infection, sutures
Introduction
There have been a significant number of studies that allude to the benefits of absorbable or nonabsorbable suturing techniques. Arguments both for and against each technique have been previously published (Kundra et al. 2010, Morritt 2011, Wade, Wormald and Figus 2018). Absorbable sutures most notably require less medical attention post op. Non absorbable sutures have been suggested to provide more tensile strength resulting in margins of incisions being in improved proximity resulting in improved wound healing time (Selvi et al. 2016). Important comparisons made between AS and NAS include post op infections, complications and
IP T
wound healing. A recent systematic review demonstrated no significant difference between NAS and
AS in healing post skin incisions, however there have been previous studies that have recorded
differing results (Sajid et al. 2014, Al-Mubarak and Al-Haddab 2013). With the ever increasing
SC R
number of systematic reviews collating data on AS and NAS, this study reviews relevant systematic reviews on NAS and AS in surgical closure of wounds.
U
Methods:
N
Medline, Embase and Cochrane library were used to find systematic reviews and meta analyses
A
comparing absorbable vs non absorbable sutures in surgical wound closure. This was defined broadly as all surgeries that required stitching of a wound post op. Studies were searched from the origin of
M
data bases until now.
MeSH search words included “absorbable sutures” “non-absorbable sutures” “surgery” “surgical
ED
incisions” “wound”. No limitations were placed such as size of study or linguistics. Chosen studies were scrutinised and data extracted by all authors. Bibliographies were further scrutinised and further
PT
papers extracted.
No methodological checklist grid (measurement tool/instrumentused to assess reviews) was used to
CC E
assess full-texts of relevant abstract selected. Study selection: Systematic reviews comparing AS to NAS involving any type of surgical wound closure.
A
Data extraction:
Two authors extracted the data from the selected papers individually then combined their results. Any differences were further discussed and advice sort from a third party.
Results
According to our research strategy, we identified N=25 abstract (10+15) of whichN=14 were duplicates and were removed. After duplicates removed, 11 records were identified for full-text assessment. Of these records, N=3 reviews were included in this systematic review of systematic reviews on AS and NAS. The systematic reviews (SRs) used were extracted from Medline, Embase, and Cochrane library database, on which we extracted details on sutures for wound closure, complications post op and infection rates. Figure 1 displays the PRISMA flowchart of the research
A
CC E
PT
ED
M
A
N
U
SC R
IP T
strategy and the screening process.
Figure 1 :Studies screeningprocess
Additional records identified through other sources (n = 10 )
A
N
Records screened (n =11 )
U
Screening
Records after duplicates removed (n =11 )
ED PT CC E
A
Included
Eligibility
M
Full-text articles assessed for eligibility (n =4 )
Studies included in qualitative synthesis (n = 3 )
IP T
Records identified through database searching (n =15 )
SC R
Identification
PRISMA 2009 Flow Diagram
Records excluded (n = 7 )
Full-text articles excluded, with reasons (n =1 )
Used both absorbable and non absorbable sutures on the same population group.
Studies included in quantitative synthesis (meta-analysis) (n =3 )
The table 1 illustrates the basic characteristics of the included SRs.For each intervention, we reported details on the following: (1) surgical site infections; (2) post op complications; (3) risk of wound dehiscence.
I N U SC R
Table 1:
Year Aim (Total no. of participants )
To complete a systematic review of randomized controlled trials (RCTs) that compare the cosmetic outcomes and complications of 2007 traumatic lacerations and surgical incisions closed with absorbable sutures versus nonabsorbable sutures (44 to 166 patients) To systematically analyse the effectiveness of delayedabsorbable (Polydioxanone; PDS) versus non-absorbable 2011 (Polypropylene; Prolene, and Nylon) for abdominal fascial closure in patients undergoing laparotomy (4261 patients) To report a systematic review of published randomized controlled trials (RCTs) investigating the role of 2014 absorbable suture (AS) against non-AS (NAS) used for the closure of surgical incisions (1354 patients)
Searchstrategy
No. of studiesincluded
Surgical site infections
7
OR of 1.00 (95% CI, 0.39– 2.56); Traumatic lacerationsOR of 0.42 (95% CI, 0.07 to 2.51).
8
OR, 0.98; 95% OR, 0.94; 95% CI, 0.68, 1.39; CI, 0.66, 1.33; z = z = 0.14; p = 0.37; p = 0.71 0.89
OR, 1.04; 95% CI, 0.67, 1.62; z = 0.19; p = 0.85
10
OR = 0.97; 95%CI: 0.56, N/A 1.69; Z = 0.11; P = 0.92
OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).
A
CC E
Sajid et al
PT
ED
Al-Abdullah et al
M
A
Author
Sajid et al
MEDLINE, EMBASE, Cochrane Central
Cochrane Colorectal Cancer Group (CCCG) Controlled Trial Register, Cochrane Central Register of controlled Trials (CENTRAL), Medline, Embase and Science Citation Index
MEDLINE, EMBASE, and Cochrane library
Post operative complications
Risk of wounddehiscence
redness at wound site after suturing: OR of 0.44 (95% CI, 0.09–2.32) OR of 0.16 (95% Swelling or CI, 0.02 to 1.45) edema at the site of suture with an OR of 1.18 (95% CI, 0.50–2.80).
I N U SC R
Quality analysis (Table 2)
A
AMSTAR CHECKLIST
A
CC E
PT
ED
M
Category Was an "a priori" design provided Was there duplicate study selection and data extraction Was a comprehensive literature search performed? Was the status of publication (i.e. grey literature) used as an inclusion criterion? Was a list of studies (included and excluded) provided? Were the characteristics of the included studies provided? Was the scientific quality of the included studies used appropriately in formulating conclusions? Were the methods used to combine the findings of studies approriate? Was the likelihood of publication bias assessed? Was the conflicit of interest stated?
Al-Abdullah et al 2007
Sajid et al 2011
Sajid et al 2014
Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Yes Yes Yes No Yes n/a Yes Yes No Yes
Yes Yes Yes No Yes Yes Yes Yes No Yes
Discussion 5781 cases of surgical wound closure were analysed. There was no significant difference noted in surgical site infections, post operative complications or risk of wound dehiscence post op. The findings of this review demonstrate that both absorbable andnon absorbable sutures are equally favourable for surgical wound closure. The conclusions of this study are consistent with previous studies. A study examining the cost
IP T
difference in cost between non-dissolving sutures, dissolving sutures and tissue adhesive noted that tissue adhesive was of more economic value and preferred by patients. However the study had a
significant small sample size and the study population was paediatric patients (Osmond, Klassen and
SC R
Quinn 1995).
The systematic reviews included studies that had significant differences in the inclusion criteria. RCTs of differing patient groups were included, including plastics, general surgery and orthopaedics
U
resulting in significant heterogeneity between the studies.
Al-Abdullah et al 2007 conducted a literature search of randomised control trials of which 7 met their
N
inclusion criteria (Al-Abdullah, Plint Ac Fau - Fergusson and Fergusson). It noted significant
A
heterogeneity between studies which could implicate their overall conclusion. Furthermore included studies had a range of sample sizes from 44 to 166, which is proven to be critical for clinical
M
application (Suresh and Chandrashekara 2012).
ED
Sajid et al 2011 included 8 RCT studies, subtotalling 4261 patients. The authors compared slow absorbable to non absorbable sutures. Although this may differ from the other two studies included in this systematic review of systematic reviews, it is valid as the population groups included were
PT
compared on factors of our studies interest and continued with the same suture throughout the trials (Sajid et al. 2011).
CC E
Sajid et al 2014 simillarly conducted a systematic review comparing NAS to AS on a range of aspects. The authors noted substantial variations in operations that were performed inlcuding orthopaedic and plastic and thus caution must be taken when interpreting the results (Sajid et al.
A
2014).
Definitions on infection of wounds, wound types, wound dehiscence and post operative complications varied. Sufficient information was not recorded on wound location or cosmetic outcomes. Improper concealment of allocation to both group and use of different absorbable sutures in some studies further impacts the quality of the systematic reviews. Furthermore only 3 systematic reviews were found to suit the inclusion criteria. Furthermore patient expectations on outcomes were not recorded, which has shown to effect overall outcome (Waljee et al. 2014).
Although the systematic reviews were of high standard (AMSTAR checklist table 2), the authors acknowledge the significant variations in study design and methodologies of included RCT’s. Due to such variants, a number of multi centre randomised control trials are needed to establish a systematic review with less heterogeneity. Almost all studies compared the two options via continuous stitch, thus it is hard to reach a conclusion if the type of stitching can affect the results.
IP T
Conclusion This study demonstrates that absorbable sutures are not superior to non absorbable sutures in the three areas examined: surgical site infections, post operative complications and risk of wound dehiscence.
SC R
However, there was significant heterogeneity between included RCTs in the systematic reviews.
Further RCTs are needed to evaluate the differences between absorbable and non absorbable sutures
U
that are reflected in size of wounds and location.
N
All authors declare no conflict of interest. Finance: No financial input.
CC E
References
M
PT
ED
All authors declare no ethical issues.
A
Ethics: Review article
A
1. Al-Abdullah, T., D. Plint Ac Fau - Fergusson & D. Fergusson Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. 2. Al-Mubarak, L. & M. Al-Haddab (2013) Cutaneous Wound Closure Materials: An Overview and Update. Journal of Cutaneous and Aesthetic Surgery, 6, 178-188. 3. Kundra, R. K., S. Newman, A. Saithna, A. C. Lewis, S. Srinivasan & K. Srinivasan (2010) Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery. Annals of The Royal College of Surgeons of England, 92, 665-667. 4. Morritt, A. N. (2011) Absorbable or non-absorbable sutures? Annals of The Royal College of Surgeons of England, 93, 183-183. 5. Osmond, M. H., T. P. Klassen & J. V. Quinn (1995) Economic comparison of a tissue adhesive and suturing in the repair of pediatric facial lacerations. J Pediatr, 126, 892-5.
A
CC E
PT
ED
M
A
N
U
SC R
IP T
6. Sajid, M. S., M. R. McFall, P. A. Whitehouse & P. S. Sains (2014) Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions. World Journal of Gastrointestinal Surgery, 6, 241-247. 7. Sajid, M. S., U. Parampalli, M. K. Baig & M. R. McFall (2011) A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg, 9, 615-25. 8. Selvi, F., S. Cakarer, T. Can, S. İ. Kirli Topcu, A. Palancioglu, B. Keskin, B. Bilgic, M. Yaltirik & C. Keskin (2016) Effects of different suture materials on tissue healing. Journal of Istanbul University Faculty of Dentistry, 50, 35-42. 9. Suresh, K. P. & S. Chandrashekara (2012) Sample size estimation and power analysis for clinical research studies. Journal of Human Reproductive Sciences, 5, 7-13. 10. Wade, R. G., J. C. Wormald & A. Figus (2018) Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. Cochrane Database Syst Rev, 2, CD011757. 11. Waljee, J., E. P. McGlinn, E. D. Sears & K. C. Chung (2014) Patient Expectations and PatientReported Outcomes in Surgery: A Systematic Review. Surgery, 155, 799-808.