Absorbable versus non-absorbable stitches for closing the wound after carpal tunnel surgery

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Absorbable versus non-absorbable stitches for closing the wound after carpal tunnel surgery

Wade RG, Wormald JCR, Figus A

What is the aim of this review?

The aim of this Cochrane review was to compare absorbable and non-absorbable material for stitching the wound after carpal tunnel surgery. We collected and analysed information on this question and found five relevant studies.

Key messages

We do not know whether absorbable or non-absorbable stitches are better for closing the wound after surgery for carpal tunnel syndrome (CTS). The studies we found only provide very low-quality evidence, which does not allow a conclusion to be made.

Only one study reported on hand function and scar satisfaction after surgery, and none provided data on side effects. We have no evidence of sufficient quality to assist choice of suture following surgery for CTS. However, absorbable stitches do not require removal and so time and cost savings could be made.

What was studied in the review?

CTS is a common condition that may affect one or both hands, with symptoms such as tingling, numbness, and weakness of the thumb and fingers. These symptoms are usually caused by pressure on the median nerve as it passes from the arm across the wrist into the palm. The nerve goes through a tunnel at the wrist made up of wrist bones and a band of thick tissue. If the size of this tunnel is too small for any reason, pressure on the nerve can lead to problems using the hand, and other symptoms of CTS.

The treatment of CTS is divided into non-surgical treatments (splints and steroid injections) and surgical treatments. Surgery for CTS is the most common non-urgent hand operation. This minor surgery is usually performed under local anaesthetic. In open carpal tunnel surgery the cut is large enough for the surgeon to see the carpal tunnel directly. In endoscopic carpal tunnel surgery, the surgeon makes two small cuts in the wrist, one for surgical instruments and the other for a small camera. Typically, the skin is closed with stitches, which are either absorbed naturally by the body (absorbable) or have to be removed (non-absorbable). Absorbable stitches are convenient, but some people think they might worsen scarring and inflammation. Non-absorbable stitches are believed to cause less inflammation and a better scar, but their removal involves greater costs and inconvenience for the patient and healthcare system.

We wanted to assess the evidence to find out whether there was a difference between these two types of suture when used for CTS surgery.

What are the main results of the review?

Following a thorough search, we found five studies (with a total of 255 participants) that compared these stitches. All the studies had some problems in design or the way they were performed. The participants in four studies had open carpal tunnel surgery and in one study they had endoscopic carpal tunnel surgery.

Due to the very-low quality of the evidence contributing to our analyses, it is uncertain whether there are differences between absorbable and non-absorbable stitches for pain at 10 days or 6 weeks after surgery, hand function, scar satisfaction or wound inflammation. The studies did not report side effects.

How up to date is this review?

The review authors searched for studies that were available up to 30 October 2017.

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