Suture Types for Carpal Tunnel and Trigger Finger Surgery

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Mayo Clinic

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

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 1-2 weeks

130 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if patient satisfaction and scar appearance differ after surgery when using two types of stitches: absorbable (which dissolve on their own) and non-absorbable (which require removal). It targets individuals undergoing surgery for carpal tunnel or trigger finger, conditions that affect hand movement. Those scheduled for one of these surgeries, without prior similar surgeries on the same hand, may qualify for this study. As an unphased trial, it offers a unique opportunity to contribute to understanding the best surgical practices for hand conditions.

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 prior data suggests that these suture types are safe for wound closure?

Research has shown that absorbable stitches are generally safe for surgeries like carpal tunnel and trigger finger procedures. These stitches lose about half of their strength in two to three weeks, eliminating the need for removal. This feature makes them convenient and comfortable for many patients.

Studies comparing absorbable and non-absorbable stitches have not identified major safety differences. Some evidence suggests that absorbable stitches might cause slightly more wound issues in certain skin types, but these problems are rare and usually not serious.

Non-absorbable stitches retain their strength longer and are also safe. They may require removal, which can be inconvenient for some patients, but they are often used without major safety concerns.

Overall, both types of stitches have been used safely and successfully in many surgeries. While small differences exist between them, both are generally well-tolerated by patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about exploring different types of sutures for carpal tunnel and trigger finger surgery because each type offers unique benefits that could improve patient outcomes. Absorbable sutures are designed to dissolve in the body over time, eliminating the need for removal and potentially reducing follow-up visits and discomfort for patients. On the other hand, non-absorbable sutures remain intact, providing long-term support to the wound site, which might be beneficial for certain patients. By comparing these two approaches, researchers hope to determine which suture type offers the best balance of healing, convenience, and effectiveness for patients undergoing these common hand surgeries.

What evidence suggests that this trial's treatments could be effective for wound closure in carpal tunnel and trigger finger surgery?

This trial will compare absorbable sutures with non-absorbable sutures for wound closure in carpal tunnel and trigger finger surgeries. Research has shown little difference in satisfaction or healing between stitches that dissolve and those that do not for these procedures. One study found that QuickDASH scores, which assess arm disability and symptoms, were nearly identical for both suture types six weeks post-surgery. Although absorbable stitches lose strength more quickly, this does not significantly affect outcomes. Monocryl, a type of dissolvable stitch, has improved patient and observer ratings in the early stages of healing. Overall, both suture types appear effective for these surgeries. ^{1 4 5 6 7}

Who Is on the Research Team?

Peter C Rhee, DO, MS

Principal Investigator

Mayo Clinic

Are You a Good Fit for This Trial?

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.

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.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Wound closure

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.

How Is the Trial Designed?

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.

Who Is Running the Clinical Trial?

Mayo Clinic

Lead Sponsor

Trials

3,427

Recruited

3,221,000+

Published Research Related to This Trial

In a study of 47 patients undergoing carpal tunnel release surgery, using a vessel loop in wound closure significantly improved patient satisfaction during suture removal, with a satisfaction score of 9.9 compared to 8.6 in the standard closure group.

The vessel loop technique also reduced pain and time for suture removal, with pain scores of 0.68 versus 2.6 and removal times of 31 seconds compared to 84 seconds in the standard group, indicating a more efficient and comfortable experience for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Including a Vessel Loop in Wound Closure Facilitates Suture Removal Following Open Carpal Tunnel Release. Frazier, MC., Tomooka, LBH., Foeger, N., et al.[2023]

In a study of 312 patients undergoing carpal tunnel and trigger finger release surgeries, incisions closed with Monocryl suture had significantly lower rates of wound dehiscence (2.1%) and infection (1.6%) compared to nylon (10.5% dehiscence, 7.4% infection) and chromic gut (10.3% dehiscence, 13.8% infection).

The analysis indicated that Monocryl not only reduced complications but also led to fewer additional wound-related encounters (8.0%) compared to nylon (16.8%) and chromic gut (24.1%), prompting its adoption as the standard suture type for these procedures at the Palo Alto Veterans Affairs Health Care System.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery. Rochlin, DH., Sheckter, CC., Curtin, CM.[2020]

In a study of 53 patients undergoing carpal tunnel decompression, both absorbable (Vicryl Rapide) and nonabsorbable (Prolene) sutures showed similar outcomes in terms of functional recovery and patient satisfaction, with no significant differences in QuickDASH and VAS scores at 6 weeks post-surgery.

Both suture types were found to be safe, with no complications reported, and all but one patient achieved excellent wound healing by 6 weeks, suggesting that surgeons can choose either type based on personal preference and handling characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical outcome and wound healing following carpal tunnel decompression: a comparison of two common suture materials. MacFarlane, RJ., Donnelly, TD., Khan, Y., et al.[2021]

In a randomized trial involving 40 hands from 33 patients, absorbable and non-absorbable sutures showed no significant difference in outcomes such as pillar pain, scar tenderness, or wound inflammation after open carpal tunnel release surgery.

Both suture types resulted in similar improvements in symptoms and functional status, as assessed by the Boston Questionnaire at 2, 6, and 12 weeks post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release. Kharwadkar, N., Naique, S., Molitor, PJ.[2009]

A systematic review of five trials involving 255 participants found no clear evidence that absorbable sutures are better or worse than non-absorbable sutures for skin closure after carpal tunnel decompression surgery, indicating very low-quality evidence.

While absorbable sutures eliminate the need for removal, which could save time and costs, the overall effectiveness and safety of either suture type remain uncertain, highlighting the need for more rigorous studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. Wade, RG., Wormald, JC., Figus, A.[2022]

A study of 329 patients undergoing trigger finger release found that using a telemedicine follow-up protocol with absorbable sutures resulted in similar clinical outcomes compared to traditional in-office follow-ups.

However, patients with absorbable sutures reported more wound complaints, indicating a potential trade-off in patient satisfaction despite comparable effectiveness in recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Absorbable Sutures and Telemedicine for Patients Undergoing Trigger Finger Release. Holbert, SE., Brown, C., Baxter, S., et al.[2023]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S0020138325003729

Increased wound complications in glabrous skin with ... Absorbable sutures lose approximately 50 % of their tensile strength within 2–3 weeks, whereas non-absorbable sutures maintain tensile strength much longer, ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4140113/

Clinical Outcome and Wound Healing following Carpal ... Results. At 6 weeks the mean QuickDASH scores postoperatively were 18.54 and 17.70 for absorbable and nonabsorbable sutures, respectively, (P = 0.86). The mean ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT03781141

Wound Closure Study in Carpal Tunnel and Trigger Finger ... The study will involve randomizing patients to wound closure with absorbable or non-absorbable sutures. We will if scar formation (symptoms and aesthetics) if ...

4. trialx.com trialx.com/clinical-trials/listings/269915/wound-closure-study-in-carpal-tunnel-and-trigger-finger-surgery/?&radius=50

Wound Closure Study in Carpal Tunnel and Trigger Finger ... Overview. Does a difference in patient satisfaction and cosmetic outcome exist between wound closure with absorbable or non-absorbable sutures.

5. journals.sagepub.com journals.sagepub.com/doi/10.1177/17531934231178383

and observer-assessed outcomes following carpal tunnel ... Monocryl suture represents an effective method for carpal tunnel closure that leads to improved patient- and observer-reported outcome scores in the early ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6491144/

Absorbable versus non‐absorbable sutures for skin closure ... To assess the effects of absorbable versus non‐absorbable sutures for skin closure after elective carpal tunnel decompression surgery in adults

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10452930/

Absorbable Sutures and Telemedicine for Patients ... The results of this study demonstrate that the use of an absorbable suture and telemedicine protocol for patients undergoing trigger finger ...