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.     

Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture)

BACKGROUND: Coated polyglactin 910 suture with triclosan was developed recently in order to imbue the parent suture, coated polyglactin 910, with antibacterial activity against the most common organisms that cause surgical site infections (SSI). Because such alterations could alter the physical properties of the suture, this study sought to compare the intraoperative handling and wound healing characteristics of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture in pediatric patients undergoing various general surgical procedures. METHODS: This was a prospective, randomized, controlled, open-label, comparative, single-center study. Pediatric patients (age 1-18 years) undergoing various surgical procedures were randomized in a 2:1 ratio to treatment with either coated polyglactin 910 suture with triclosan or coated polyglactin 910 suture. The primary endpoint was the surgeon's assessment of the overall intraoperative handling of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture without triclosan. The secondary endpoints included specific intraoperative suture handling measures and wound healing assessments. The suture handling measures were (1) ease of passage through tissue; (2) first-throw knot holding; (3) knot tie-down smoothness; (4) knot security; (5) surgical handling; (6) surgical hand; (7) memory; and (8) suture fraying. Assessment of wound healing included the following: Healing progress, infection, edema, erythema, skin temperature, seroma, suture sinus, and pain. Adverse events were recorded. RESULTS: Scores for intraoperative handling were favorable and not significantly different for both sutures, although coated polyglactin 910 suture with triclosan received more "excellent" scores (71% vs. 59%). Wound healing characteristics were comparable for both sutures except for pain on postoperative day 1. Significantly fewer patients treated with polyglactin 910 suture with triclosan reported pain on day 1 than patients who received the other suture (68% vs. 89%, p = 0.01). The overall incidence of adverse events was 18%; none was devicerelated. CONCLUSIONS: Coated polyglactin 910 suture with triclosan performed as well or better than traditional coated polyglactin 910 suture in pediatric patients undergoing general surgical procedures. The incidence of postoperative pain was significantly less in patients treated with coated polyglactin 910 suture with triclosan than the traditional suture. We speculate that polyglactin 910 suture with triclosan, by inhibiting bacterial colonization of the suture, reduced pain that can be an indicator of "subclinical" infection. Coated polyglactin 910 suture with triclosan may be a useful alternative in patients at increased risk of developing SSI.     

In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture

ABSTRACT Background: This study evaluated the efficacy of polydioxanone suture with and without triclosan against gram-positive and gram-negative bacteria in vitro and in vivo. Methods: Polydioxanone suture with and without triclosan was tested against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. In vivo evaluations were conducted in guinea pigs and mice in which test and control sutures (3-4 cm long) were implanted subcutaneously in the dorsal-lateral regions (control on left, test on right, 3-5 cm apart) through a 20 gauge catheter. Each implantation site was then challenged directly through the catheter with 4 x 10(5) colony-forming units (CFU) of S. aureus (guinea pigs) or 7 x 10(6) CFU of E. coli (mice). At 48 h post-implantation, the control and test sutures were explanted, and adherent bacteria were counted. Results: Polydioxanone suture with triclosan demonstrated activity against all test organisms in vitro. The antibacterial activity was maintained until the sutures dissolved after 17 to 23 days when tested against E. coli and S. aureus, respectively. Evaluation in animal models demonstrated a 99.9% reduction in S. aureus and a 90% reduction in E. coli relative to controls. Conclusion: Polydioxanone suture with triclosan had activity in vitro against S. aureus, MRSA, E. coli, S. epidermidis, MRSE, and K. pneumoniae that persisted for as long as three weeks. In animal models, polydioxanone suture with triclosan inhibited in vivo colonization by S. aureus and E. coli.     

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.     

Study of the efficacy of coated Vicryl plus antibacterial suture in an animal model of orthopedic surgery

PURPOSE: To evaluate the efficacy in vitro and in vivo of a new antibacterial suture, polyglactin 910 suture with triclosan, compared with a traditional braided suture, polyglactin (Vicryl), in a validated animal model of orthopedic infection. Our primary goal was to compare the microbiologic effectiveness of the two sutures. The secondary goal was to evaluate histopathologic signs of an inflammatory response. METHODS: We used 20 Sprague-Dawley rats. Samples of Staphylococcus epidermidis were diluted to a 0.5 McFarland concentration (100,000 colony-forming units/mL). A surgical steel suture was placed in the spinous process of the rats, and the deep zone of the incision was contaminated bilaterally. Wounds were closed with one of the sutures. After 16 days, the animals were sacrificed, and the surgical wounds were reopened, with cultures being performed of both the zone adjacent to the implant and the deep region of the wound. We also studied the histopathologic features of the tissue adjacent to the implant. RESULTS: No clinical signs of infection were observed. The culture of the zone adjacent to the implant was positive in nine animals in the polyglactin group vs. three in the polyglactin 910 with triclosan group (p = 0.005). Culture of the deep zone of the wound was positive in ten animals in the polyglactin group vs. six in the polyglactin 910 with triclosan group (p = 0.03). We found predominant polymorphonuclear neutrophil populations in four samples in the polyglactin group vs. two in the polyglactin 910 with triclosan group. CONCLUSIONS: Under simulated conditions of severe intraoperative contamination, the antibacterial suture reduced the number of positive cultures after surgery by 66.6%. Judging from the available clinical information, its use might contribute to reducing the number of infected implants by 25.8%. Human studies are needed to determine the clinical implications of these results.     

Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination?

BACKGROUND: Surgical site infections are associated with severe morbidity and mortality. The role of surgical sutures in the etiology of surgical site infection has been the objective of discussion for decades. This study used a standardized in vitro microbiologic model to assess bacterial adherence and the antibacterial activity of a triclosan-coated polyglactin 910 (braided) suture against selected Gram-positive and Gram-negative clinical isolates that may infect surgical wounds. STUDY DESIGN: Standardized cultures (2.0 log(10) colony forming units/mL and 5.0 log(10) colony forming units/mL of three clinical strains, Staphyllococcus aureus (methicillin-resistant S aureus [MRSA]), S epidermidis (biofilm-positive) and Escherichia coli (extended-spectrum beta-lactamase [ESBL]-producer) were inoculated to triclosan-coated and noncoated polyglactin 910 sutures to evaluate comparative adherence of bacterial isolates to the antibacterial coated and noncoated surgical sutures; to assess the impact of serum proteins (bovine serum albumin) on antibacterial activity of triclosan-coated suture; and to document the duration of antibacterial activity of the triclosan-coated material. Selected suture samples were prepared for scanning electron microscopy to demonstrate bacterial adherence. RESULTS: Substantial (p < 0.01) reductions in both Gram-positive and Gram-negative bacterial adherence were observed on triclosan-coated sutures compared with noncoated material. Pretreatment of surgical sutures with 20% BSA did not diminish antibacterial activity of the triclosan-coated braided device compared with noncoated suture (p < 0.01), and antibacterial activity was documented to persist for at least 96 hours compared with controls (p < 0.01). CONCLUSIONS: The in vitro model demonstrated a considerable reduction (p < 0.01) in Gram-positive and Gram-negative bacterial adherence to a triclosan-coated braided suture, which was associated with decreased microbial viability (p < 0.001). Because bacterial contamination of suture material within a surgical wound may increase the virulence of a surgical site infection, treating the suture with triclosan provides an effective strategy for reducing perioperative surgical morbidity.     

Knotting and handling characteristics of coated synthetic absorbable sutures

The purpose of this study was to evaluate the knotting and handling characteristics of the new coated synthetic absorbable sutures. When compared to the coated polyglactin 910 sutures, the coated polyglycolic acid sutures displayed a lower coefficient of friction, encountered less tissue drag forces, and exhibited less flexural rigidity. In the case of sizes O, 2-O, and 3-O coated polyglycolic sutures, knot security was achieved with one less throw than with similar sizes of coated polyglactin 910 sutures. On the basis of these comprehensive mechanical performance tests, the knotting and handling characteristics of the coated polyglycolic acid sutures were judged to be superior to that of the coated polyglactin 910 sutures.     

A Study of the Efficacy of Antibacterial Sutures for Surgical Site Infection: A Retrospective Controlled Trial

To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity were developed. The aim of this study was to evaluate whether the incidence of surgical site infections can be reduced when triclosan-coated sutures are used. Until December 2009, we used conventional polyglactin 910 sutures (VICRYL, Ethicon) for the closure of the fascia in digestive tract surgery. Therefore, for the control group we retrospectively collected surveillance data for 1.5 years. In the control group, 611 patients underwent digestive tract surgery with VICRYL sutures. Beginning in July 2010, we used triclosan-coated polyglactin 910 sutures (VICRYL Plus, Ethicon, Tokyo, Japan) for the closure of the fascia in all digestive surgeries. So, we collected data for the study group from July 2010 until June 2011. In the study group, 467 patients underwent digestive tract surgery with triclosan-coated VICRYL Plus sutures. In the control group, 75 patients (12.2%) developed wound infections. In the study group, 31 patients (6.6%) developed wound infections, which was significantly lower. Emergency cases; laparoscopic cases, including some cholecystectomy and colectomy cases; American Society of Anesthesiologists classification; the use of immunosuppressive therapy; colostomy cases; wound classification; and suture material were identified as the risk factors for wound infections. In both groups, as the wound classification worsened, the wound infection rate increased. Triclosan-coated polyglactin 910 antimicrobial sutures lead to a significant decrease in the incidence of surgical site infections, especially in clean/contaminated cases.     

Coated polyglactin 910—A new synthetic absorbable suture

Physical properties of newly developed synthetic absorbable sutures, “coated polyglactin 910”, were compared with findings in two conventional synthetic absorbable sutures. Clinical results of application in 108 cases in Japan (123 clinical cases in number of tissues approximated) were also evaluated. Our findings clearly indicate that coated polyglactin 910 sutures may well become the sutures of choice for various surgical applications.     

Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament,braided, and barbed sutures

Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan‐coated Vicryl Plus. In our study, sutures were cultivated on color‐change agar with Staphylococcus aureus , Staphylococcus epidermidis , Enterococcus faecium , Escherichia coli , and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p < 0.001), but 1.4 times larger than on Ethilon II (p < 0.001) regarding S. aureus . Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925–933, 2017.

     

Polyglactin 910 suture in urinary tract

Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract.     

Common bile duct healing. Do different absorbable sutures affect stricture formation and tensile strength?

Few basic investigations have addressed the problem of common bile duct strictures. We systematically investigated the healing canine end-to-end choledochal anastomosis and tested the hypothesis that common bile duct anastomoses sutured with monofilament polyglyconate absorbable suture would heal with less stricture formation and greater tensile strength than those sutured with braided polyglactin 910 and chromic catgut sutures. Seventy-six canines, randomized to control vs sutured groups, underwent either mobilization (controls) or transection of the mid-common bile duct and were allowed to heal 5, 10, 15, or 50 days postoperatively before sacrifice. The type of absorbable suture used to construct a common bile duct anastomosis was found to have no major effect on anastomotic strictures nor on anastomotic breaking strength. Polyglyconate suture caused significantly less perianastomotic inflammation than did chromic suture, with polyglactin 910 sutures evoking an intermediate inflammatory response. Surgeons may safely choose sutures for biliary procedures based on the clinical circumstances and personal preference.     

Irradiated Polyglactin 910 (Vicryl Rapide) for Placement of Full-Thickness Skin Grafts

BACKGROUND: The "unsuture" technique originally reported with the use of fast-absorbing gut for the placement of full-thickness skin grafts has provided years of successful full-thickness graft placement without the need for suture removal. OBJECTIVE: The objective was to explore another option for successful graft placement and survival using irradiated polyglactin 910 (Vicryl Rapide, Ethicon Inc, Somerville, NJ, USA), with its longer tensile strength of 7 to 10 days. METHODS: Irradiated polyglactin 910 was used to suture the edges and place basting sutures in full-thickness skin grafts. RESULTS: In our experience, we have found that the use of irradiated polyglactin 910 for the placement of full-thickness skin grafts provides an alternative to the "unsuture" technique with fast-absorbing gut. It provides excellent graft survival, easy workability, low inflammation, and good long-term cosmesis, without the need for suture removal. CONCLUSION: Irradiated polyglactin 910 provides another option for the placement of full-thickness skin grafts without the need for suture removal.     

A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.     

Impact of using triclosan-antibacterial sutures on incidence of surgical site infection

Background

Surgical site infection is a common complication of surgery. Its morbidities range from delayed healing to systemic sepsis. It has impact on the economy and health care resources.

Methods

This study was a prospective, randomized, double-blinded, controlled multicenter study aimed to compare triclosan-coated polyglactin 910 sutures with polyglactin 910 sutures for the reduction of surgical site infections. This article details the results from the Cairo University center. A total of 450 patients who had undergone different surgical procedures were enrolled; 230 were enrolled in the study group and 220 were enrolled in the control group.

Results

The study group and the control group were comparable regarding risk factors for surgical site infection. Surgical site infection incidence was 7% in the study group and 15% in the control group (P = .011). The mean extended stay as a result of infection was 3.71 days, with an average cost $91 US per day.

Conclusions

Use of the triclosan-coated polyglactin 910 antimicrobial suture lead to reduction of surgical site infection and has an impact on saving health care resources. The triclosan-coated polyglactin 910 antimicrobial suture could save $1,517,727 yearly in this single center.     

Heat welding for surgical sutures

The purpose of this experimental study was to test the potential value of heat welding to cut the ends of knotted surgical sutures. This heat process resulted in knot security in a coated polyglactin suture with fewer throws than those needed for the same suture with knotted ends cut by scissors. Results of mechanical performance testing of the knotted sutures cut either by scissors or welding did not differ significantly. With refinements in the technical design of the heat source, suture welding may have important applications in surgery.     

Effect of human pancreatic juice and bile on the tensile strength of suture materials

BACKGROUND: Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. METHODS: Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. RESULTS: Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. CONCLUSIONS: We found that polidioxanone was the strongest suture material in pancreatic juice.     

Polydioxanon (PDS)--a new monofilar synthetic, absorbable suture material. Tensile strength studies in a controlled clinical trial on the large intestine of humans and physical parameters in in vitro tests

We investigated the properties of tensile strength for the following suture materials: Polyglycolic acid (2. and 3.generation), Polyglactin 910 (3.generation) and Polydioxanon. They were situated within human large bowels for 10 to 12 days and investigated in a controlled experimental procedure. The decrease of the tensile strength in the human large bowel is significantly slower for polydioxanon suture (PDS) than for PGA (2. and 3.generation) and Polyglactin 910 (3.generation) suture. As PDS-suture are primarily less tractable than the others, there is no significant difference of tractability between all sutures after 11 days of implantation within the human colon. For PGA (3.generation) and Polyglactin 910 we found a strong loss of tractability after 10 to 12 days. In a second experimental series tensile strength, knot breaking security and knot holding capacity were tested in a tensiometer for absorbable suture materials with 3 and 6 parallel knots. The tensile strength was higher than the knot security for all sutures. Coated suture material (PGA and Polyglactin 910, both 3.generation) as well as the new monofile polydioxanon must be knotted manyfold for a secure knot position.     

Characterization of the deposition of collagen fibers and lithogenic potential in bladder of rats submitted to a sugar cane biopolymer graft

Objectives: Suture materials are widely used in urology. The interaction of these materials with the extracellular matrix in the inflammatory process can be estimated by stereology of collagen fibers and the present study was designed to determine the behavior of the bladder tissue of rats to grafts of the biopolymer of sugar cane (BPCA), and the inflammation and intravesical stone formation compared to the polyglactin 910. Materials and Methods: 42 Wistar rats were divided in four groups: Group I (n = 10) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 4 weeks; Group II (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 4 weeks; Group III (n = 12) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 8 weeks; Group IV (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 8 weeks. Bladders collected at necropsy were analyzed for their weight and the presence of grafts and calculi. Sections were prepared for stereological analysis of collagen fibers. Results: The bladder weight was higher in group I, particularly in the presence of bladder stones. The presence of the graft was observed in 100 % (group I), 80 % (group II), 91.6 % (group III) and 30 % (group IV); polyglactin 910 showed an absorption of 70 % in this period. The stereological analysis showed a higher volume density of collagen fibers in group I versus other groups (p < 0.001). Conclusion: The BPCA was a material with good integration into the bladder of rats; its absorption was slower than that of the polyglactin 910. The presence of urinary stones was lower in bladders with implantation of BPCA, particularly after 8 weeks. There was a greater initial inflammatory response to BPCA graft that was directly related to the increase in bladder weight and the presence of urinary stones, but that equalized the results of polyglactin 910 after 8 weeks.     

Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures.

OBJECTIVE: To compare the cosmetic outcome, pain and tenderness around the operation scar of carpal tunnel syndrome surgery using either nylon, polyglactin 910 or stainless steel sutures for skin closure. METHODS: A randomised clinical trial comparing nylon, polyglactin 910 or stainless steel sutures for skin closure in 61 patients undergoing carpal tunnel syndrome surgery was performed. Pain, tenderness, scar hypertrophy, redness and the presence of granulomas were assessed in all patients at ten days and six weeks after surgery and compared by non-parametric statistical tests. RESULTS: Adequate surgical decompression of the median nerve could be achieved in all patients. All but two patients experienced significant relief of tingling of the fingers. Nearly all patients reported some degree of discomfort around the scar. At ten days, the mean pain score was 1.7 (+/-2.2), 3.1 (+/-2.3) and 1.9 (+/-2.3) for the nylon, vicryl and steel groups, respectively. At six weeks, the pain score was 3.6 (+/-3.1), 3.4 (+/-2.6) and 2.7 (+/-2.1) for the nylon, vicryl and steel groups, respectively. The infection rate was 0%, 8% and 0% for the nylon, vicryl and steel groups, respectively. Suture granulomas were significantly more present in the vicryl group (p<0.05). There were no statistical differences in redness or hypertrophy of the wound between the three groups. CONCLUSIONS: Nylon and stainless steel sutures are both suitable for skin closure after carpal tunnel surgery. Based on this study, absorbable vicryl sutures should not be used, since the incidence of infections and the presence of suture granulomas was much higher than in the nylon and steel suture groups.