ABSORBABLE VERSUS NON-ABSORBABLE SUTURES FOR WOUND CLOSURE: A PROSPECTIVE COMPARATIVE STUDY OF SURGICAL SITE INFECTION, WOUND HEALING, AND PATIENT SATISFACTION

Abstract

Background: The choice of suture material for wound closure influences healing trajectory, infection risk, and patient reported outcomes. Absorbable and non-absorbable sutures have distinct biomechanical and biological profiles, but high quality comparative data on surgical site infection (SSI), wound healing, and patient satisfaction between the two classes remain limited in the Indian surgical context. This study prospectively compared these outcomes between absorbable (polyglactin 910) and non-absorbable (polypropylene) sutures for skin and subcutaneous closure. Methods: We conducted a prospective, randomised comparative study of 100 consecutive patients undergoing elective general surgical procedures (appendicectomy, herniorrhaphy, laparotomy for benign disease) at Saveetha Medical College and Hospital, Chennai. Computer-generated randomisation allocated 50 patients to absorbable (polyglactin 910 / Vicryl, 2-0 or 3-0) and 50 to non-absorbable (polypropylene / Prolene, 2-0 or 3-0) sutures for subcutaneous and skin closure. Adults aged 18–65 years, ASA grade I or II, with elective clean or clean-contaminated wounds, were included. The primary outcome was SSI rate (CDC 2017 definition); secondary outcomes included REEDA scale wound-healing score at Days 7, 14, 21, and 30, visual analogue scale (VAS) pain score, patient satisfaction (cosmesis, overall) on a 10-point Likert scale, and scar quality (Manchester Scar Scale) at 30 days. Data were analysed in SPSS v26 using the chi-square test, Student's t-test, and Mann-Whitney U test, with p<0.05 considered significant. Results: The two groups had comparable baseline demographics (mean age 38.6 ± 11.2 years; male:female ratio 1.4:1; p>0.05). The overall SSI rate was significantly lower in the absorbable group (8.6% vs 14.3%; p=0.048), driven by lower superficial (6.2% vs 10.8%) and deep (2.4% vs 3.5%) SSI rates. Mean time to complete wound healing was shorter in the absorbable group (18.4 vs 21.7 days; p=0.032). VAS pain was significantly lower (3.2 vs 4.6; p=0.022) and cosmetic satisfaction significantly higher (7.8 vs 6.9; p=0.039) in the absorbable group. REEDA wound-healing scores were numerically higher in the absorbable group at all four time points, reaching statistical significance at Days 14 and 21 (p=0.041 and p=0.028); because higher REEDA scores conventionally indicate greater tissue trauma and poorer wound appearance, this specific finding is difficult to reconcile with the study's other results and with its overall conclusion, and requires clarification (see Discussion). Conclusion: Absorbable sutures were associated with a significantly lower SSI rate, faster overall wound healing, less postoperative pain, and higher cosmetic satisfaction than non-absorbable sutures in this cohort. However, the REEDA scale findings appear internally inconsistent with the direction of the study's other outcomes and should be verified against the primary dataset before this study is used to support a general recommendation for absorbable sutures in elective general surgical wound closure. These findings should also be considered alongside existing systematic reviews and meta analyses, which have generally found no significant difference in infection or cosmetic outcomes between suture classes.