PROSPECTIVE RANDOMISED CONTROLLED TRIAL COMPARING NORMAL INTERRUPTED MATTRESS SUTURES WITH TRACTION LOOP SUTURES IN THE CLOSURE OF SURGICAL WOUNDS IN THE HINDFOOT

Abstract

Introduction: Closure with interrupted mattress sutures is useful where careful skin apposition is required following hindfoot surgery. However, suture removal around the hindfoot can be awkward and painful. Modification with an additional loop creates a “traction loop suture”. We hypothesise this technique makes removal easier and reduced tension placed on sutures during their removal reduces pain.

Materials: 17 patients undergoing elective hindfoot surgery were included. Nylon suture was used for all wound closures. Suturing and removal techniques were standardised. Ethical approval and patient consent was obtained.

Methods: Half of each wound length was sutured normally and the other with traction loop sutures (both interrupted mattress type). Follow-up was at 2 and 6 weeks. Comparison of time taken for suture removal and associated wound complications were noted for both. Pain scores during suture removal were recorded using a screen to “blind” the patient and a visual analogue pain score (VAPS) was obtained. Statistical analysis calculated p-values at the 5% significance level and 95% confidence intervals (CI).

Results: Traction loop sutures were 20% faster to remove than normal interrupted sutures (mean difference 19.3 seconds, CI 5.39 to 33.1 seconds, p-value 0.004). Traction loop sutures were also 20% less painful during removal (mean difference 1.05 on VAPS, CI 0.021 to 2.085, p-value 0.027. At 2 weeks, 1 normally sutured wound suffered complications. At 6 weeks, no complications were noted in either group.

Discussion: Traction loop sutures provide a statistically significant method of reducing pain and time during suture removal. The study method could be applied to comparisons of other skin closures where removal is required. The technique is novel and requires minimal change in suturing.

Conclusion: Pain levels and time taken for removal of interrupted mattress sutures are significantly reduced using the traction loop suture technique in hindfoot surgery. The study is continuing.