Locking vs Standard Sutures for Surgical Wounds

Overseen By Keemberly Kim, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Davis

Disqualifiers: Incarceration, Under 18, Pregnant, others

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

Compensation: Varies

Number of Visits: 1

Duration: Immediate post-surgery

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two methods for stitching surgical wounds on the head or neck to determine which causes less scarring. One half of the wound will be closed with standard running stitches, while the other half will use running locking stitches, which might improve healing. Individuals undergoing head or neck surgery who can return for follow-up visits are suitable candidates for this study. As an unphased trial, it offers patients the chance to contribute to innovative research that could enhance surgical outcomes.

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

Research has shown that continuous stitches, including locking stitches, are generally safe for closing wounds. One study found that about 3.6% of wounds closed with continuous stitches became infected. Both regular and locking stitches are usually well-tolerated and carry a low risk of infection.

Locking stitches hold wound edges more tightly, potentially improving healing and reducing scarring. However, experts continue to study the best methods for wound closure.

Regular continuous stitches are commonly used and considered safe. They are often the first choice for closing wounds, but if the thread breaks, the wound might reopen.

In summary, both types of stitches are generally safe and widely used. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the effectiveness of different suturing techniques for closing surgical wounds. Unlike the standard running suture, which is commonly used for wound closure, the running locking suture technique may offer improved wound healing by providing more even tension distribution and potentially reducing the risk of wound dehiscence, or reopening. By comparing both techniques on the same wound, researchers hope to determine if the locking method offers superior cosmetic outcomes and better overall wound integrity. This trial could lead to advancements in surgical practices that enhance patient recovery and reduce complications.

What evidence suggests that these suturing techniques could be effective in reducing scarring?

This trial will compare locking stitches and standard running stitches for surgical wound closure. Research has shown that locking stitches can improve wound healing by reducing tension, potentially leading to less scarring. Studies have found these stitches to be generally safe and may lower the risk of wound complications. Regular running stitches are often used because they quickly close long wounds and distribute tension evenly. Both types of stitches are effective, but locking stitches might result in better-looking scars due to their design. While both methods are common, locking stitches could be more effective at reducing visible scars after healing. ^{1 2 3 4 6}

Who Is on the Research Team?

Daniel Eisen, MD

Principal Investigator

University of California, Davis - Dermatology

Are You a Good Fit for This Trial?

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 scheduled for skin surgery on my head or neck that will be closed up right away.

Exclusion Criteria

Incarceration

Pregnant Women

I am under 18 years old.

Timeline for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

Interventions

• Running locking suture
• Standard running suture

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.

How Is the Trial Designed?

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.

Who Is Running the Clinical Trial?

University of California, Davis

Lead Sponsor

Trials

958

Recruited

4,816,000+

Published Research Related to This Trial

The running vertical mattress suture is an efficient technique in dermatologic surgery that can save time and improve wound closure.

This suture method is effective for achieving wound eversion, controlling bleeding, and closing wounds that are under mild tension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Running vertical mattress suture. Kolbusz, RV., Bielinski, KB.[2019]

In a study of 206 adult patients undergoing appendectomy, continuous intradermal absorbable sutures were found to be as safe as traditional interrupted nonabsorbable sutures in preventing wound infections.

The use of continuous absorbable sutures is recommended for all open appendectomies due to their safety and additional benefits, even in complicated cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Wound healing after open appendectomies in adult patients: a prospective, randomised trial comparing two methods of wound closure. Kotaluoto, S., Pauniaho, SL., Helminen, M., et al.[2021]

The running vertical mattress suturing technique is a fast and straightforward method that effectively evens out skin edges, similar to the traditional simple vertical mattress technique.

This technique is easy to learn and results in excellent alignment of wound edges, making it a practical choice for wound closure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Running vertical mattress suturing technique. Stiff, MA., Snow, SN.[2019]

In a study of 737 patients with midline incisions, using a short stitch length (less than 10 mm from the wound edge) significantly reduced the rates of surgical site infections (5.2% vs. 10.2%) and incisional hernias (5.6% vs. 18.0%) compared to a long stitch length.

The findings suggest that a long stitch length is an independent risk factor for complications, indicating that current practices should be revised to improve patient outcomes and reduce costs associated with wound complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Millbourn, D., Cengiz, Y., Israelsson, LA.[2022]

The combination of horizontal running mattress sutures with intermittent loops provides effective wound eversion while minimizing cosmetic issues, such as railroad track marks, associated with traditional non-absorbable sutures.

This technique has shown functional and cosmetic benefits in patients, making it a teachable and practical option for achieving better aesthetic results in surgical closures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Horizontal running mattress suture modified with intermittent simple loops. Chacon, AH., Shiman, MI., Strozier, N., et al.[2021]

Continuous running sutures are beneficial for wound closure but can pose challenges during removal.

Using a loop tied around the running suture or an adjacent interrupted suture can improve visibility and facilitate easier removal of the sutures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The recovery suture. Leslie, D.[2019]

Excessive twisting of sutures during abdominal closure significantly reduces their tensile strength, with polydioxanone losing up to 39% of its strength after multiple twists, highlighting a critical factor for surgical practice.

Surgeons should be cautious of axial torsional forces when using sutures, as twisting can compromise the mechanical properties and elasticity of the material, potentially impacting surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Torsion of monofilament and polyfilament sutures under tension decreases suture strength and increases risk of suture fracture. Hennessey, DB., Carey, E., Simms, CK., et al.[2012]

The running locked intradermal suture technique offers a continuous and buried closure method for simple elliptical wounds, promoting better cosmetic results and reducing dermal dead space.

This technique not only minimizes the risk of wound infection and the need for postoperative care but also eliminates the necessity for suture removal, making it a convenient option for facial surgeries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The running locked intradermal suture. A cosmetically elegant continuous suture for wounds under light tension. Wong, NL.[2019]

The continuous vertical mattress suture technique described provides a simple and rapid method for closing surgical wounds, ensuring good hemostasis and proper alignment of wound edges.

This technique, used routinely since 1984, minimizes the risk of ischemia at individual stitches and offers satisfactory cosmetic results while being economical in material use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Surgical wound closure with continuous sutures]. Simek, K.[2016]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9797933/

Comparing running vs interrupted sutures for skin closure The overall infection rate was 4.4% (3.6% in the continuous suture group and 5.2% in the interrupted suture group). We did not find a ...

2. trialx.com trialx.com/clinical-trials/listings/293075/outcomes-of-running-locking-suture-vs-standard-running-suture-in-surgical-wounds/?&radius=10&place=All%20Participating%20Sites&user_country=Germany

Outcomes of Running Locking Suture vs Standard ... In this study, half the wound will be stitched with standard running sutures and the other half will be stitched with running locking sutures.

3. jaad.org jaad.org/article/S0190-9622(24)00974-5/abstract

Aesthetic outcome of running subcuticular suture versus ... To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects.

4. withpower.com withpower.com/trial/phase-surgical-wound-2-2024-41712

Locking vs Standard Sutures for Surgical Wounds Research indicates that continuous running sutures, including locking types, are generally safe for wound closure in humans. They can reduce the risk of wound ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S0972978X21000283

Is continuous locking suture with braided ... To the best of our knowledge, the evidence for the optimal wound closure has not been clearly developed, and the data related to the postoperative outcomes ...

6. emedicine.medscape.com emedicine.medscape.com/article/1824895-technique

Suturing Techniques Technique The first knot of a running locked suture is tied as in a traditional running suture and may be locked by passing the needle through the loop ...