Comparative analysis of suture choice in open bilateral carpal tunnel surgery: a randomized controlled trial

OBJECTIVE: This randomized controlled trial (RCT) compared outcomes of absorbable and non-absorbable sutures for skin closure in open carpal tunnel decompression. METHODS: Patients diagnosed with bilateral carpal tunnel syndrome proceeding to staged open carpal decompression were invited to participate in the trial. Patients elected left or right hand for the first operation and were randomized to receive Prolene (non-absorbable) or Vicryl Rapide (absorbable) first, and the alternative suture to the contralateral side. Recorded pre-operative data included the Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. At 2 weeks post-operatively the BCTQ, a Visual Analogue Score (VAS) for pain and Asepsis Wound Score were recorded. At 6 weeks, the BCTQ and VAS were repeated and a Patient and Observer Scar Assessment Scale (POSAS) was performed. Patients were asked preference for left or right suture. Statistical analysis using a linear mixed model assessed improvements in the BCTQ, as well as wound scores between sutures. The individual scales were compared using non-parametric Wilcoxon signed rank test. Specific patient factors including age, comorbidities, and previous steroid injections were evaluated for their impact on outcome. RESULTS: There was no significant difference between the two suture types in any of the overall recorded assessments, complications or patient preferences. BCTQ scores improved significantly post-operatively, P = 0.001. Previous steroid injection, diabetes and age over 65 did not affect outcomes. CONCLUSIONS: Patients can be advised there is no difference in the outcome following open carpal tunnel decompression from using either absorbable or no-absorbable suture material for skin closure.