Do absorbable sutures exacerbate presternal scarring?

Area of Science:

• Plastic Surgery
• Surgical Techniques
• Wound Healing

Background:

• Midline sternotomy is a common surgical approach.
• Optimizing cosmetic outcomes of sternotomy incisions is important for patient satisfaction.
• Suture material and wound tension can influence scar formation.

Purpose of the Study:

• To compare the cosmetic results of absorbable versus nonabsorbable sutures for midline sternotomy closure.
• To evaluate the impact of incision location (upper vs. lower) on scar quality.
• To identify factors contributing to suboptimal cosmetic outcomes in sternotomy scars.

Main Methods:

• A randomized clinical trial involving 60 patients undergoing midline sternotomy.
• Comparison of absorbable polyglycolic acid sutures and nonabsorbable polypropylene sutures in different incision segments.
• Objective and photographic assessment of scar width and height at 6 months post-surgery.

Main Results:

• The lower half of the sternotomy incision exhibited significantly poorer cosmetic results in both groups (P < 0.05).
• The upper incision segment closed with absorbable polyglycolic acid sutures showed increased hypertrophic scarring.
• Nonabsorbable monofilamentous polypropylene sutures were associated with better cosmetic outcomes compared to absorbable sutures.

Conclusions:

• Monofilament nylon sutures reduce the risk of hypertrophic scarring after midline sternotomy compared to absorbable sutures.
• Increased tension and skin mobility in the lower sternotomy region negatively impact cosmetic results.
• Suture material choice and understanding biomechanical forces are crucial for improving sternotomy scar aesthetics.