Skin closure in carpal tunnel release operation: A comparison of three different methods - Nylon, Monocryl and Undyed vicryl

Background: Carpal tunnel decompression release is a common procedure performed to release the compression of the median nerve at the wrist that usually causes symptoms of hand weakness, pins and needles affecting the thumb, index finger, middle finger, and the thumb side of the ring fingers. Patients usually drop things because of poor grip and in more than half of cases both sides, the right and left are affected (1). Symptoms typically start gradually and during the night (2). Pain may extend up the arm (2). Weak grip strength may occur and after a long period of time the muscles at the base of the thumb; the abductor pollicis brevis, flexor pollicis brevis and the opponenspollicis that forms the Thenar Eminence at the base of the thumb on the volar aspect may waste away. The causes of Carpal Tunnel Syndrome (CTS) are multifactorial and treatment could be conservative or surgical, conservative treatment involve; physiotherapy, steroids administration either orally or injected locally, splinting, and the surgical treatment involve the release of the transverse carpal ligament (3,4). Surgery is recommended when night-splinting or other conservative interventions no longer control intermittent symptoms (5,6). The skin wound can be closed by either a simple interrupted stitches or by an intradermally placed suture. Objective: This is a prospective randomised three-cohort study to compare the use of an absorbable suture; polyglactin {undyed vicryl rapid – group A}, Poliglecrapone {Monocryl – group B} and a non-absorbable suture, Polyamide {Ethilon - group C}, in wound closure after elective carpal tunnel decompression. The primary outcome was scar management as assessed by direct phone calls to patients and review of medical records. The cost of the wound closure materials were compared as a secondary outcome. In all we assessed 110 patients in a follow up of between 14 to 36 months post-operatively. There was no significant difference in the three groups regarding scar management postoperatively. Method and Materials: We reviewed the medical records of all patients who had carpal tunnel decompression within the3 years period (between 2015 to 2017) and the skin wound was closed with nylon, monocryl or undyed vicryl. Phone calls were made to 150 patients but we got responses from 110 patients and also reviewed the medical records for any evidence of any scar reassessment for continuous dressing and use of antibiotics because of wound redness, swelling, discharge or evidence of palpable collection. Within this period time frame only one patient reported scar sensitivity, no patients had wound infection, wound break down or collection needing further incision and drainage. This is a retrospective study, to help us evaluate our quality of care, review our surgical methods and improve as appropriate. Result: All the surveyed patients had no complications relating to the wound closure post-surgery. Conclusion: This is a quality improvement audit, helping us to review and evaluate the quality of CT release operations in Hinchingbrooke Hospital. The material used for wound closure in CTR.