A Randomized Trial between Different Suture Materials (Polydioxanone vs. Poliglecaprone 25) and Different Suturing Techniques (Running Subcuticular Suture Alone vs. with Running Horizontal Mattress) in Prevention of Hypertrophic Scar Development in Median Sternotomy Wound
Boonlawat Homvises MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Hypertrophic scar development after median sternotomy wound in cardiac surgery patients is quite common
in surgical practice and becomes a major concern nowadays.
Objective : To compare cosmetic outcome between different suture materials and different suture techniques for skin closure
in median sternotomy wound.
Material and Method: A randomized clinical trial was conducted in 80 patients who underwent cardiac surgery in Thammasat
University Hospital, Thailand. In respect of the materials and the techniques used to suture the skin, the patients were
randomly allocated to four groups. In group 1, the skin was closed with subcuticular running 4-0 Poliglecaprone 25
(Monocryl). In group 2, the skin was closed with subcuticular running 4-0 Polydioxanone (PDS). In group 3, the skin was
closed with subcuticular running 4-0 Poliglecaprone 25 (Monocryl) and running horizontal mattress 6-0 Nylon. In group 4,
the skin was closed with subcuticular running 4-0 Polydioxanone (PDS) and running horizontal mattress 6-0 Nylon.
Postoperative evaluation was performed at 2 and 6 weeks, 3 and 6 months follow-up visits. The scar was analyzed in three
parts: upper, middle and lower one third of the sternal wound. The outcome measures for surgical wound were width, height
and overall appearance of the scar using the Vancouver scar scale (VSS). A linear visual analogue score (VAS) was
preformed to assess pain and itch.
Results : At 6 months, there were no significant differences between 4 groups of patients in every parameters (width, height,
VSS, pain score and itch score) at three different wound sites (upper, middle and lower). There was a statistically significant
and progressive increase in scar stretching, height and total VSS from top to bottom of the sternum with the same pattern in
all groups of patients (p<0.05). At 6 months, scar showed a statistically significant difference in width when compares to 6
weeks and 3 months (p<0.001).Female had a statistically significant difference of scar stretching at upper two third of the
sternum (p<0.05). Female scar width was approximately 2 folds greater than male patient. During follow-up in group 3, two
patients died postoperatively due to multi-organ failure and one patient developed wound infection.
Conclusion : There were no significant differences in cosmetic outcomes between different suture materials and different
suture techniques.
Keywords : Polydioxanone, Poligiecaprone 25, Running horizontal mattress, Hypertrophic scar development, Median sternotomy wound
