Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631).

Monofilament synthetic absorbable suture materials offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual bio-absorption. An investigation was conducted on 72 rats to compare three types of monofilament absorbable suture material (Polydioxanone, Poliglecaprone 25, Glycomer 631), with respect to their clinical characteristics, tissue inflammatory reaction and suture absorption times. The results identified different qualities for each suture: Poliglecaprone 25 and Glycomer 631 suture materials were found to be less reactive than Polydioxanone in rat skin. However, because of their extremely low tissue reaction values, all three materials were deemed particularly suitable for use as intracuticular sutures. Absorption times in rat skin were less than 3 months for Poliglecaprone 25, between 3 and 6 months for Glycomer 631 and 6 months for Polydioxanone. The differences in suture characteristics which were detected in our study can help in the surgical selection of the most appropriate suture material.     

In vivo antibacterial efficacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan)

BACKGROUND: This study evaluated the ability of poliglecaprone 25 suture with triclosan to inhibit bacterial colonization by Escherichia coli and Staphylococcus aureus in mouse and guinea pig models. METHODS: Test and control sutures (3-4 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 3-5 cm apart) in 10 female Hartley guinea pigs (300-400 g) and 10 Swiss Webster mice (20-35 g) via a 20-gauge catheter. The test material was poliglecaprone 25 suture with triclosan (2-0, undyed), and the control material was poliglecaprone 25 suture (2-0, undyed). In the guinea pig model, each implantation site was challenged directly with 4x10(5) colony-forming units (cfu) of S. aureus, whereas in the mouse model, each implantation site was challenged directly with 1.3x10(7) cfu of E. coli through an indwelling catheter. At 48 h post-implantation, the control and test sutures were explanted, and bacterial enumeration was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered in the study groups 48 h post-implantation. Poliglecaprone 25 suture with triclosan produced a 3.4-log reduction in S. aureus and a 2-log reduction in E. coli compared with standard poliglecaprone 25 suture without triclosan under the same challenge conditions. The difference between the study groups in the number of bacteria recovered was significant (p < 0.05). CONCLUSION: Poliglecaprone 25 suture with triclosan inhibited bacterial colonization of the suture compared with untreated suture after direct in vivo challenge with S. aureus and E. coli in animal models.     

In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan)

BACKGROUND: This study evaluated the in vitro efficacy of poliglecaprone 25 suture with triclosan against gram-positive and gram-negative bacteria. METHODS: Poliglecaprone 25 sutures with and without triclosan were tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. The suture also was tested against Escherichia coli in a colonization assay in a dynamic model simulating in vivo conditions. An in vitro triclosan diffusion assay and a sustained efficacy assay were performed by concurrent high-performance liquid chromatography and zone of inhibition assay. To assess stability, antibacterial efficacy testing was performed on samples held more than five months at elevated temperature. RESULTS: Poliglecaprone 25 suture with triclosan demonstrated significant in vitro efficacy against a range of bacteria. The suture sustained in vitro efficacy for 11 days, corresponding to the in vitro triclosan diffusion profile. CONCLUSION: Triclosan reduced in vitro colonization of poliglecaprone 25 suture by several strains of bacteria compared with untreated control sutures.     

A comparative evaluation of 9-0 monofilament and 9-0 braid polyglactin 910 in cataract surgery (intracapsular, extracapsular, and phacoemulsification)

This study describes the operative and postoperative performance of 9-0 monofilament and 9-0 braid Polyglactin 910 synthetic absorbable sutures in cataract surgery. The evaluation represents a clinical comparison of the sutures in 150 cataract surgical procedures. In a comparative evaluation each suture provided specific performance advantages: (table: see text). To date, the 9-0 monofilament and 9-0 braid Polyglactin 910 sutures are the smallest useful absorbable sutures developed for cataract surgery. While these sutures seem safe for use with phacoemulsification as sole wound closure materials, we recommend the use of nylon stints for intracapsular and extracapsular procedures until further experience is gained.     

Effectiveness of glycomer 631 monofilament sutures in closing musculoaponeurotic incisions

The purpose of this study was to quantitate the effect of two monofilament synthetic absorbable sutures as well as a new monofilament synthetic absorbable suture, glycomer 631, in healing musculoaponeurotic incisions in rats. Because these three monofilament synthetic absorbable sutures provided secure closure of laparotomy incisions, their clinical use in laparotomy incisions is recommended.     

Foot and Ankle Surgical Incision Closure With Three Different Materials

There is no clear recommendation for wound closure material in foot and ankle surgery. Thus, we hypothesized that there was no difference in clinical outcomes among 3 suture materials, namely, absorbable sutures, nonabsorbable sutures, and metallic staples. This study compared the 3 materials for wound closure in foot and ankle surgery. In this prospective randomized study, 124 patients were randomly divided into the nonabsorbable suture group, absorbable suture group, and staple group. ASEPSIS score, Hollander Wound Evaluation Scale, and numerical rating scale (regarding pain and satisfaction) were collected at first dressing changes, suture removal, and 6 weeks after surgery. Suture time and incision length were recorded. No significant differences were detected for the ASEPSIS and Hollander Wound Evaluation Scale scores. There was significantly more pain after 6 weeks in the nonabsorbable suture group. The closure time (13 s/cm) with staples was significantly lower in the nonabsorbable suture group than in the other groups. Regardless of wound closure material, male sex and obesity appeared to be associated with a higher risk for the occurrence of wound complications. The 3 suture materials showed no significant differences regarding the frequency of wound complications. Staples and absorbable sutures should therefore be considered in the repertoire of suture materials used in foot and ankle surgery.     

GS27PTECHNIQUES FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONS

Background A recent meta‐analysis of randomised controlled trials of abdominal fascial closures concluded that in order to reduce incisional hernia rates without increasing wound pain, or the rate of dehiscence slowly absorbable continuous sutures appear to achieve the best results in abdominal fascial closures. We surveyed the techniques for abdominal fascial closure among general surgeons in Canberra, Australia. Methodology 49 out of 80 surgeons responded to the survey by form. The information collected included the seniority of the surgeon, the frequency of laparotomy closure, surgical technique and suture material utilised in abdominal fascial closure. Results 34 (69%) of the surgeons surveyed preferred a non‐absorbable monofilament suture material for abdominal fascial closure with nylon being the most popular. Most (38, 78%) also preferred a non‐absorbable monofilament suture in emergency surgery. 12 (24%) surgeons preferred to use slowly absorbable suture. The majority of surgeons (37, 76%) preferred continuous suture technique, whilst only 2 (4%) used continuous followed by interrupted suture closures. Only 5 (10%) complied with the dual recommendation of continuous suture technique and slowly absorbable suture. Conclusion The majority of surgeons preferred non‐absorbable monofilament suture rather than slowly absorbable suture. Only 1 in 10 surgeons complied with both components of evidence base, which supports the use of slowly absorbable suture material and a continuous technique in abdominal fascial closure. A definitive RCT would confirm this observation.     

A comparative study on primary wound closure by subcuticular suture using different suture materials with emphasis on complications, cosmesis and cost-effectiveness

Background and Purpose

There are different methods and materials for closing a surgical wound by subcuticular stitch but controversy prevails as concerns the appropriate material for this stitch. This study aims to investigate the different suture materials and compare their technical accessibility, usefulness, complication rates, patient satisfaction and, above all, the general outcome.

Methodology

Over a period of 8 months (June 2011–January 2012), 160 patients underwent wound repair by subcuticular stitch in our unit. A prospective analysis of patients’ case notes was performed. Results: Each type of thread has its own and specific type of complications which is distinct from other types of threads. Among patients on whom polyglactin sutures were used, 15.79% and 14.29% (respectively) developed complications in the presence and absence of complicating comorbid factors. Specifically, 20% of <3 cm wounds, 10% of 3–6 cm wounds, and 20% of >6 cm wounds sutured with polyglactin developed complications. The corresponding complication rates for poliglecaprone sutures were less at 9%, 5.9%, and 8.3%, respectively. The number of patients who are very happy and satisfied with poliglecaprone sutures is much greater than that of those on whom polyglactin sutures were used; the difference is statistically significant. In terms of cost, nylon is the cheapest thread whereas polypropylene is the costliest.

Conclusion

Poliglecaprone seems to be the thread of choice with minimal complication rates both in the presence and absence of comorbid factors in < 3 cm and 3–6 cm wounds. However, nylon appears to be more useful for wounds > 6cm since minimal complication rates are reported.     

Monofilament absorbable sutures in median sternotomy.

BACKGROUND: The most common material used for closure of median sternotomy incision is steel suture in open heart surgery. Some complications and disadvantages have been investigated recently. These complications are the breaking down of steel suture, erosion of sternum tabulae especially in osteoporotic patients, erosion of the dermis especially in patients with thin subdermic layer and cause of infection. Another disadventage of steel suture material is cosmetic problems or discomfort. For these reasons some suture materials such as silk, polyfilament polyester, monofilament material, polypropylene have been used recently. Silk and polyester have a risk of high infection, and polypropylene causes granulation tissue according to the number of knots. These facts encouraged the usage of an absorbable suture material. The available polyfilament absorbable sutures in the market a few years ago had a short absorption time, causing sternal infection and dehiscence. Polydiaxone, a monofilament suture material introduced recently has a considerably longer absorption time. METHODS: 153 sternal closures were performed with monofilament absorbable suture material in a period of seven months at the Ko?uyolu Heart and Research Hospital. The mean age of the patients was 32.55, ranging from 8/12 to 71 years. The mean body weight is 48.37, ranging between 7 kg and 75 kg. RESULTS: Only two patients had sternal dehiscence. CONCLUSIONS: We conclude that monofilament absorbable suture is a safe alternative for all kinds of steel suture material for closure of sternotomy.     

A revolutionary advance in skin closure compared to current methods

Six pigs were used to evaluate the influence of three separate modalities on contaminated wounds. Full-thickness skin wounds on the abdomen were contaminated with 10(4) or 10(5) Staphylococcus aureus and then closed with one of three methods. The three closure modalities included (1) a new absorbable staple (Insorb) placed in the subcuticular tissue, (2) a braided Vicryl suture, and (3) percutaneous metal staples. Any foreign body material implanted in tissue increases the risk of infection at that site. Wound closure always involves the use of a foreign body. Historically, sutures have been the primary material used to close tissue. The newer synthetic sutures are significangly more biodegradable and cause less infection than sutures composed of protein, such as silk and catgut. Metal staples are also associated with a low risk of infection. Recently, Incisive Surgical, Inc. (Plymouth, Minnesota) has developed an absorbable polymer staple specifically for subcuticular skin closure. The purpose of this study was to compare the new Insorb staple to both an absorbable polymer suture and a metal staple. Wound infection was assessed 7 days after closure by clinical signs and quantitative bacterial swabs. The results demonstrated that wounds closed with Insorb staples had the lowest incidence (33%) of infection, followed by percutaneous metal staples (44%). All wounds (100%) closed with Vicryl suture became infected. The incidence of wound infection directly correlated with the level of quantitative bacterial count at analysis. The Insorb staple was associated with significantly reduced closure time, less inflammation and infection, and better aesthetic result compared to Vicryl. Compared to metal staples, the Insorb subcuticular staplers demonstrated comparable closure time without the need for later staple removal. In conclusion, the closure of contaminated wounds with the Insorb staples is a superior choice to Vicryl suture because they have a significantly (p = 0.009) lower incidence of infection. The Insorb staple is a revolutionary advance in subcuticular skin stapling.     

Intracutaneous butterfly suture – a horizontal buried interrupted suture for high tension

Background: Tension on surgical wound margins frequently results following the excision of skin lesions such as tumors, naevi or scars. This tension is commonly counteracted with buried, intracutaneous, interrupted sutures of absorbable or non-absorbable material anchored vertically in the corium. Method: A horizontal, buried, intracutaneous suture has now been developed which can be more firmly anchored in the corium. It adapts and everts wound margins nearly as broadly as two vertical sutures, particularly, when the wound edges are cut obliquely with a longer rim of epidermis. When finished, the suture has a butterfly shape, whence its name. It can also be laid as a double suture (double butterfly suture). In creating this sutures, the surgeon changes the customary direction of the needle holder from horizontal to vertical. Materials: Since 1985, this suture has been made with polydioxanon in more than 30000 skin lesion excisions with very good results. In most cases the resulting narrow and smoth scars were narrow and flat in the most cases. During the study, the following suture materials were tested prospectively in 1325 patients: polyglactin 910 (Vicryl^®) (n=390), polytrimethylcarbonate (Maxon^®) (n=95), poliglecaprone 25 (Monocryl^®) (n=175), and (PDS^®) (n=665). Results: The results were unsatisfactory in only 8% of procedures. Polyglactin 910 was accompanied by somewhat more inflammation and scar dehiscence, poliglecaprone 25 by a high rate of scar dehiscence. Polytrimethylcarbonate caused skin reactions in 23% and was discontinued. Suture perforation occurred in 9%. Polydioxanon yielded the best results (p-value of the difference <0.05). Conclusions: The butterfly suture has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.     

Prospective, Randomized, Blinded Study of a New Wound Closure Film Versus Cutaneous Suture for Surgical Wound Closure

BACKGROUND Wound closure devices include sutures, tissue adhesives, adhesive strips, and staples. Recent studies suggest no differences between various tissue adhesives and sutures for dehiscence, infection, and satisfaction when assessed by patients or surgeons. To date, no studies have investigated ClozeX (Clozex Medical LLC, Wellesley, MA, USA), a novel adhesive strip, for closure of surgical incisions.
OBJECTIVE To compare surgical wounds repaired with ClozeX versus suture.
METHODS A prospective, randomized study was conducted, in which 15 patients with surgical incisions were allocated to closure with ClozeX on half of the wound and monofilament suture on the other half. Physician satisfaction with blinded assessment, patient satisfaction, complication rates, and closure times were recorded.
RESULTS Application with ClozeX was faster than with suture ( p =.007). There were no complications in either group. Sixty-nine percent of the patients gave ClozeX a higher satisfaction score ( p =.02). More physicians were satisfied with the ClozeX half than with the suture half ( p =.007).
CONCLUSIONS This pilot study demonstrates ClozeX to be a safe and effective closure device. The cosmetic outcome seems to be at least as good as simple running suture. Physicians and patients were generally more satisfied with ClozeX. No difference was found in the rate of dehiscence or infection between the groups.     

Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure

Various methods of skin closure exist in joint replacement surgery. Although subcuticular skin closure techniques offer an aesthetic advantage over conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-Loc absorbable suture (Covidien, Mansfield, Massachusetts), theoretically distribute tension evenly through the wound and help decrease knot-related complications. The purpose of this study was to evaluate whether wound complication rates were (1) lower in V-Loc closure cases as theoretically suggested, (2) lower for subcuticular closure vs staples, and (3) significantly different for knee and hip joint reconstruction.A retrospective chart review was conducted of 278 consecutive cases of primary joint reconstruction performed by a single surgeon (L.P.). The study group comprised 106 men and 161 women. Average patient age at surgery was 63 years (range, 18-92 years), and average body mass index of the cohort was 33.7 kg/m(2) (range, 25-51 kg/m(2)). Skin was closed via staple gun or subcuticular stitch (3-0 Biosyn [Covidien] vs V-Loc). Seven (3.9%) wound complications occurred in 181 cases closed with staples. Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Six (13.0%) wound complications occurred in 46 cases closed with V-Loc suture. The staple group had a lower rate of complications when compared with the suture group as a whole (P=.033) and when compared specifically with the V-Loc suture group (P=.017).     

Modified laparoscopic gastrostomy tube placement in children: Does subcutaneous suture type matter?

BackgroundLaparoscopic gastrostomy tube (GT) placement carries the risk of early tube dislodgement and is often modified with absorbable subcutaneously-tunneled transabdominal tacking sutures that can aid in tube replacement. However, these buried sutures may increase the risk of surgical site infection (SSI). This study sought to evaluate SSI rates associated with different types of transabdominal tacking sutures used in modified laparoscopic GT placement.MethodsA single-institution, retrospective review was performed of all patients ≤18 years-old undergoing modified laparoscopic GT placement between September 2016 and March 2020. Patients were stratified into three groups by suture type used, and the primary outcome was SSI within six weeks of surgery. Demographic and perioperative data were analyzed by chi-square or Fisher's exact test.ResultsA total of 113 modified laparoscopic GT placements were performed at a median age of 9 months (interquartile range 3 months to 3 years). Prophylactic antibiotic use was similar between groups. Eleven patients (10%) developed an SSI, and all were treated with antibiotics alone. No SSIs were observed with the use of poliglecaprone suture (n = 46), and higher SSI rates were observed with use of polyglactin (n = 17) and polydioxanone (n = 51) suture (18% polyglactin vs. 16% polydioxanone vs. 0% poliglecaprone, p<0.05). No differences were observed in rates of early postoperative dislodgement, leakage, or granulation tissue.ConclusionAbsorbable braided and long-lasting monofilament transabdominal tacking sutures may increase risk of SSI following modified laparoscopic gastrostomy tube placement. In this cohort, the use of poliglecaprone (Monocryl) suture was associated with no SSIs and similar rates of postoperative dislodgement, leakage, and granulation tissue.Level of Evidence: Treatment Study, Level III     

Abdominal wound closure comparing the proximate stapler with sutures

Proximate staple closure of transverse and vertical abdominal wounds is compared with suture closure in a prospective, blind, randomized trial. Fifty-seven wounds were randomly allocated to 3/0 Prolene or Proximate staple closure. Each wound was photographed after removal of staples or sutures and again in the sixth postoperative week. The photographic slides were independently assessed by eight observers, who graded the cosmetic result of each wound on a scale from 1 to 10. The cosmetic score in transverse wounds closed with sub-cuticular sutures was better than with staples. Cosmetic scores in vertical wounds were almost equal for staples and sutures. Staple closure was faster than suture closure. Proximate staple closure is considered a suitable and faster method for vertical abdominal wounds.     

Wound Healing after Open Appendectomies in Adult Patients: A Prospective, Randomised Trial Comparing Two Methods of?Wound Closure

Background

The skin is closed in open appendectomy traditionally with few interrupted nonabsorbable sutures. The use of this old method is based on a suggestion that this technique decreases wound infections. In pediatric surgery, skin closure with running intradermal absorbable sutures has been found to be as safe as nonabsorbable sutures, even in complicated cases. Our purpose was to compare the safety of classic interrupted nonabsorbable skin closure to continuous intradermal absorbable sutures in appendectomy wounds in adult patients.

Methods

A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two groups of wound closure: the interrupted nonabsorbable (NA) suture and the intradermal continuous absorbable (A) suture group. Primary wound healing was controlled on the first postoperative day, at 1?week clinically and after 2?weeks by means of a telephone interview. Follow-up data were obtained from 185 patients (90 in group NA and 95 in group A).

Results

Continuous absorbable intradermal suturing was as safe as nonabsorbable sutures in regard to wound infections.

Conclusion

Continuous, absorbable sutures can be used safely even in complicated appendicectomies without increasing the risk of wound infection. Considering the benefits of absorbable suturing, we recommend this method in all open appendectomies.     

Absorbable and nonabsorbable sutures in microsurgery: standardized comparable studies in rats

In order to study the applicability and value of synthetic absorbable suture materials in microvascular surgery, 8-0 monofilament nonabsorbable polyamide sutures and 8-0 absorbable polyglycolic acid and polyglactin 910 sutures were used in end-to-end anastomoses of the aorta in rats, employing the same microsurgical model for all procedures. Comparable investigations of the anastomotic sites were carded out macroscopically and histologically at various intervals postoperatively. It was found that when placed under unphysiologic strain, microvascular anastomoses sutured with absorbable materials had less mechanical endurance than anastomoses stitched with nonabsorbable suture materials. It was also found, however, that this had no significance in vivo, inasmuch as no vascular ruptures or aneurysms appeared with either the absorbable or nonabsorbable sutures even after long-term observation. The nonabsorbable sutures were fully recognizable up to 150 days, microscopically showing clear evidence of granuloma formation. The absorbable sutures, on the other hand, could hardly be discerned after 50 days, and after 150 days the foreign body and scar reactions had almost completely disappeared. Absorbable suture materials lead to more rapid restitution of the vascular wall than nonabsorbable sutures and consequently appear to be superior.     

The Principles of Abdominal Wound Closure

Background : Incisional hernia (IH) is a common complication of abdominal surgery. Its incidence has been reported as high as 39.9%. Many factors influence IH rates. Of these, surgical technique is the only factor directly controlled by the surgeon. There is much evidence in the literature on the optimal midline laparotomy closure technique. Despite the high level of evidence, this optimal closure technique has not met wide acceptance in the surgical community. In preparation of a clinical trial, the PRINCIPLES trial, a literature review was conducted to find the best evidence based technique for abdominal wall closure after midline laparotomy.

Methods : An Embase search was performed. Articles describing closure of the fascia after midline laparotomy by different suture techniques and/or suture materials were selected.

Results : Fifteen studies were identified, including five meta-analyses. Analysis of the literature showed significant lower IH rates with single layer closure, using a continuous technique with slowly absorbable suture material. No significant difference in IH incidence was found comparing slowly absorbable and non absorbable sutures. Furthermore, a suture length to wound length ratio of four or more and short stitch length significantly decreased IH rates. Conclusions : Careful analysis of the literature indicates that an evidenced based optimal midline laparotomy closure technique can be identified. This technique involves single layer closure with a running suture, using a slowly absorbable suture with a suture length to wound length ratio of four or more and a short stitch length. We adopt this technique as the PRINCIPLES technique.     

Considerations in the choice of sutures for wound closure of the genitourinary tract

The ideal suture for use within the urinary tract should maintain its tensile strength until wound repair is satisfactory and then it should undergo rapid total absorption without promoting stone formation. The bladder has a great potential for repair, attaining 100 per cent of the strength of the unwounded tissue in 14 to 21 days. Braided synthetic absorbable sutures appear to be suited ideally for closure of incised wounds of a urinary conduit. They maintain their tensile strength for approximately 21 days, during which time the healing tissues regain strength rapidly. Because sutures are foreign bodies and have access to urine, they may serve as a nidus for stone formation. Several factors that have been identified as important determinants of foreign body urolithiasis include the presence of urine, urine volume and pH, infection, physical and chemical configuration of the foreign body, and animal species. The incidence of suture urolithiasis is related directly to the duration in which the sutures are present in the urinary tract. Consequently, absorbable sutures are preferred over nonabsorbable sutures for closure of wounds of the urinary conduit. In the absence of infection braided synthetic absorbable sutures have distinct advantages over gut sutures for closure of urinary tract wounds. They are absorbed by nonenzymatic hydrolysis in a predictable manner with limited inflammatory response. In contrast, gut sutures have an unpredictable absorption rate by enzymatic degradation and elicit an exaggerated inflammatory response. Because infected urine, especially Proteus species, accelerates the degradation of absorbable synthetic sutures to a greater degree than gut sutures, wound closure in the presence of infection should be accomplished with the absorbable natural fiber suture. Nonabsorbable sutures or staples should not be used in the urinary tract because they predictably promote urolithiasis.     

Performance Comparison of Nylon and an Absorbable Suture Material (Polyglactin 910) in the Closure of Punch Biopsy Sites

The ability to close biopsy sites primarily without the need for removing sutures is obvious. However, it was unclear whether absorbable sutures could be used for this purpose. We prospectively studied 10 healthy volunteers on whom one 3 mm punch biopsy was performed on each arm. In each subject two sutures were compared for closure of the biopsy sites, polyglactin 910 and nylon. Our primary goal was to compare absorbable and nonabsorbable sutures in the closure of punch biopsy sites. Each site was closed with one simple percutaneous suture. The sites were evaluated at 2 weeks and 6 months for redness, infection, dehiscence, scar hypertrophy, and patient satisfaction. We found no statistically significant difference between the two suture materials in any of the above parameters. Therefore we conclude that absorbable sutures are a good alternative in the primary closure of skin biopsy sites.