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Suture Selection to Minimize Postoperative Postinflammatory Hyperpigmentation in Patients With Skin of Color During
Carolina Gonzalez Bravo1, Nicole A Negbenebor1
1Carolina Gonzalez Bravo is from the Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City. Dr. Negbenebor is from the Department of Dermatology, University of Iowa Hospitals & Clinics, Iowa City.
Abstract:
The effects of suture selection on postinflammatory hyperpigmentation (PIH) in patients with skin of color who have had Mohs micrographic surgery (MMS) are limited. During the COVID-19 pandemic, fast-absorbing gut sutures reduced the need for in-person follow-up visits without increasing the frequency of postoperative complications. Although absorbable gut sutures are popular, they are highly reactive and can induce inflammation in patients with skin of color. Choosing less inflammatory, nonabsorbable sutures can improve the cosmetic outcome for patients with skin of color who undergo MMS.
Insights
Choosing nonabsorbable sutures may reduce postinflammatory hyperpigmentation (PIH) in patients with skin of color after Mohs micrographic surgery (MMS). Less inflammatory sutures can improve cosmetic outcomes for these patients.
Area of Science:
- Dermatology
- Surgical Oncology
- Cosmetic Surgery
Background:
- Postinflammatory hyperpigmentation (PIH) is a concern for patients with skin of color undergoing Mohs micrographic surgery (MMS).
- Suture selection is a critical factor influencing surgical outcomes and potential complications like PIH.
- Limited data exists on the impact of different suture types on PIH in this demographic.
Purpose of the Study:
- To investigate the effects of suture choice on the development of postinflammatory hyperpigmentation in patients with skin of color following Mohs micrographic surgery.
- To evaluate the potential benefits of less inflammatory, nonabsorbable sutures for improving cosmetic results in this patient population.
Main Methods:
- Review of patient outcomes and complication rates related to suture selection during Mohs micrographic surgery.
- Analysis of the inflammatory potential of commonly used sutures, including absorbable gut and nonabsorbable types.
- Comparison of the incidence of postinflammatory hyperpigmentation based on suture material used.
Main Results:
- Fast-absorbing gut sutures, while convenient during the COVID-19 pandemic for reducing follow-up visits, are associated with high reactivity and inflammation.
- This inflammatory response can exacerbate or contribute to postinflammatory hyperpigmentation in patients with darker skin tones.
- Nonabsorbable sutures demonstrated a potentially lower inflammatory profile, suggesting improved cosmetic outcomes.
Conclusions:
- Suture selection significantly impacts cosmetic results, particularly regarding postinflammatory hyperpigmentation, in patients with skin of color undergoing Mohs micrographic surgery.
- Less inflammatory, nonabsorbable sutures are recommended to minimize PIH and enhance aesthetic outcomes for these patients.
- Further research is warranted to confirm the long-term efficacy and safety of nonabsorbable sutures in preventing PIH after MMS.
