This systematic literature review looked at studies comparing facial skin closure with absorbable versus non-absorbable sutures. Studies not published in English or looking at areas other than the head and neck, and studies focused on suture technique rather than material were excluded. Eleven studies were included from a total of 1552 screened. Primary outcomes were the physician-evaluated cosmetic outcome, and secondary assessment by the patient using a visual analogue scale, as well as infection, wound dehiscence, hypertrophy, erythema, or suture marks. Results were displayed in forest plots, demonstrating no difference in outcomes between non-absorbable and absorbable sutures, for any of the primary or secondary outcomes. This is interesting as traditionally absorbable suture materials (which are often braided) have been thought to be associated with increased risk of infection from harboured bacteria in the braided multifilament structure.
The authors conclude that most preferred to use absorbable sutures for convenience, cost and avoiding the additional patient discomfort associated with removal of sutures, and this systemic review has demonstrated that there is no reason to advise against the use of absorbable suture materials for use on wounds of the head and neck.
The authors note that the overall quality of evidence to support this conclusion is poor and that there is no consistency in the methods used for cosmetic assessment of outcomes. The lack of a valid outcome assessment scale for scars hampered the objectivity and comparability of these studies, and they included both adult and paediatric cases although wound healing and scar perception in these groups is different.
