title: Significant differences in skin irritation by common suture materials assessed by a comparative computerized objective method.
abstract: BACKGROUND
  Erythema can be described only through subjective evaluation, except when it is quantified by digital image analysis software. Using such software, the authors performed comparisons of the erythema produced after skin closure of clean surgical wounds. Five suture materials were compared with respect to the local skin irritation that was caused. Different quantities of erythema are produced by suture material after the skin closure of clean surgical wounds. The authors present an objective method of measuring how unreactive a suture material is in comparison with another when applied to the skin.
  
  
  METHODS
  The suture materials polydioxanone, polypropylene blue, polyamide 6, metallic clips, and polyglactin were compared in the present study. Digital photographs of 100 patients were compared by means of software, evaluating red color superiority (mean value of red color) in the region surrounding the wound.
  
  
  RESULTS
  The least to most irritation caused to the skin by different suture materials was established for paired data. The Kolmogorov-Smirnov criterion and the Wilcoxon signed rank test were used. Polydioxanone was found to have the best performance, followed in order by polyglactin, polyamide, polypropylene, and metallic clips. Immediately after suture removal, differences between the effects of suture materials were statistically significant on postoperative day 10.
  
  
  CONCLUSIONS
  Absorbable sutures can be used in skin closure of clean surgical wounds and can produce less erythematous reaction than nonabsorbable ones. Digital image analysis is a reliable method of quantitative evaluation of skin erythema resulting after skin closure of surgical wounds.
authors.affiliation: Athens and Herakleion, Greece From the Department of Plastic Surgery and Burns, KAT Hospital, Athens; and the Departments of Surgical Oncology and Dermatology, Herakleion University Hospital.
authors.forename: Sofia M
authors.initials: SM
authors.lastname: Parara
authors.forename: Andreas
authors.initials: A
authors.lastname: Manios
authors.forename: Eelco
authors.initials: E
authors.lastname: de Bree
authors.forename: Androniki
authors.initials: A
authors.lastname: Tosca
authors.forename: Dimitris D
authors.initials: DD
authors.lastname: Tsiftsis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D062109:Dermatologic Surgical Procedures; D004890:Erythema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005549:Foreign-Body Reaction / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014945:Wound Healing; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials