Skin closure in hip surgery: subcuticular versus transdermal. A prospective randomized study

A randomized parallel-group clinical trial was conducted between March 1991 and December 1993 to compare the effectiveness of subcuticular suture using absorbable material (Dexon) and continuous transdermal blanket suture using nonabsorbable material (silk) in hip surgery. Eighty patients (48 females and 32 males) aged between 19 and 94 years (average 71.4 years) who underwent 97 hip operations were studied. Patients were followed up between 2 and 20 months. The two groups were evaluated with respect to infection rate, patient satisfaction with the scar, extra time and cost in removal of suture and the cosmetic appearance assessed by a plastic surgeon evaluating photos of patients' wounds using a specific scoring method without knowledge of the suturing method used. Five patients died during the study. There was no significant difference in superficial infection rate between the two groups (5% with positive bacteriological swab and 16% requiring extra antibiotics on clinical grounds). No deep infection was suspected in either group. The average score of patient satisfaction with the scar was 9.6/10 in the subcuticular group and 8.68/10 in the continuous mattress with a significant difference between the two groups (p < 0.05). Cosmetic evaluation by the plastic surgeon using a 6-category scoring system showed a better cosmetic result in the subcuticular group with a significant difference (p < 0.01). An average of 17 minutes of extra nursing time was needed for removal of suture material in the nonabsorbable group in addition to the cost of the suture removal set. We conclude that absorbable subcuticular skin closure is an effective method and offers some advantages over the traditional transdermal suturing method in hip surgery.