Do absorbable sutures exacerbate presternal scarring?

Abstract

We investigated cosmetic outcomes of the midline sternotomy incision. A randomized clinical trial was conducted in 60 patients who underwent surgery through a midline sternotomy incision. Patients were divided into groups A (n=30) and B (n=30). In addition, the incision line was also divided into 2 regions (upper and lower halves) in each group. In group A, the upper half of the skin was closed with absorbable 4-0 braided polyglycolic acid sutures (Sentesorb(R), Boz, Ankara, Turkey), and the lower half was closed with 4-0 nonabsorbable monofilamentous polypropylene suture (Monoplene(R), Boz), and vice versa in group B. Scar width and height were measured and photographed at the 6th postoperative month. In both groups, the lower part of the incision showed inferior cosmetic results, regardless of the suture material (P <0.05). On the other hand, the upper part of the incision in group A (the area of absorbable polyglycolic acid sutures) was significantly more hypertrophic. We conclude that monofilament nylon sutures diminish the risk of hypertrophic scarring, in comparison with absorbable sutures. In the lower half of the sternotomy scar, increased tension and relative mobility of the skin over the xiphoid process lead to inferior cosmetic results, regardless of the suture material used.