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

Trial Summary

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}

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.

Research Team

Daniel Eisen, MD

Principal Investigator

University of California, Davis - Dermatology

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

Exclusion Criteria

Incarceration

Pregnant Women

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

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
• 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.

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.

Who Is Running the Clinical Trial?

University of California, Davis

Lead Sponsor

Trials

958

Recruited

4,816,000+

Findings from Research

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]

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]

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 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]

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]

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 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]

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]

References

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

Running vertical mattress suture. [2019]

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

The recovery suture. [2019]

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

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

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

Horizontal running mattress suture modified with intermittent simple loops. [2021]

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

Running vertical mattress suturing technique. [2019]

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]

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]

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

[Surgical wound closure with continuous sutures]. [2016]

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]