Suture Choice After Carpal Tunnel Release — Religion or Science?

It can, and should, be science — and patients can guide us here

What’s the Claim?

We almost hesitated to cover this because surgeons’ approaches to closing incisions sometimes seems more like religion than science, but ours is a scientific discipline, so here goes . . .

A randomized clinical trial compared closure with interrupted nonabsorbable suture to interrupted absorbable suture (buried 4-0 Moncryl dermal sutures versus 4-0 nylon horizontal mattress sutures) in patients undergoing open carpal tunnel release, and found at 2 weeks after surgery:

  • Patients rated the absorbable closure as preferable in terms of scar thickness, irregularity, and total score (using the validated Mean Patient Scar Assessment Scale)
    • The between-group differences probably were large enough to be considered clinically important
    • There were no differences in terms of pain, itching, color, or stiffness
  • Independent observers (not the surgeons themselves) rated the absorbable closures as superior in all metrics
    • The between-group differences generally were small and may not have been clinically important

There were no between-group differences at 6 weeks after surgery, but there’s still something you can use here, so read on.

How’s It Stack Up?