Randomized controlled trial comparing subcuticular absorbable suture with conventional interrupted suture for wound closure at elective operation of colon cancer.
BACKGROUND
Subcuticular closure provides a superior cosmetic result in clean wounds. The aim of this work was to investigate the safety in terms of postoperative infection and cosmetic effectiveness of subcuticular wound closure after elective colon cancer surgery in clean-contaminated wounds.


METHODS
Patients who underwent elective resection of colon cancer were randomized to interrupted subcuticular and interrupted transdermal suture groups. The large bowel was prepared by mechanical washout with polyethylene glycol. All patients received metronidazole and kanamycin orally and flomoxef sodium once parenterally for antimicrobial prophylaxis. The primary end point was the incidence of incisional surgical-site infections within 30 days after operation. We assessed noninferiority of subcuticular suture within a margin of 10%. Analysis was by intent-to-treat. Secondary objectives include comparison of wound closure time, comfort, and cosmesis of the scar and satisfaction of patients. This study was registered with UMIN-CTR, UMIN000003005.


RESULTS
A total of 293 patients were randomized to the two groups. Incisional surgical-site infection rates were 11.0% (90% confidence interval 7.0-16.3%) for both groups. The relative risk of subcuticular suture was 1.00 (0.58-1.73, one-tail P = .57). Interrupted subcuticular suture was noninferior to interrupted transdermal suture (P = .0088). Throughout 6 months after operation, patients expressed a significant preference for the subcuticular suture technique, noting rapid relief from pain, decreased vascularity, and smaller width, although the procedure took twice as long.


CONCLUSIONS
Subcuticular suture did not increase the incidence of wound complications in elective colon cancer operation. Patients preferred a technique of interrupted subcuticular closure, citing better cosmetic results, and less pain.
Department of Surgery, Tokai University School of Medicine, Shiokasuya, Isehara, Kanagawa, Japan. Electronic address: atanaka@is.icc.u-tokai.ac.jp.
Akira
A
Tanaka
Department of Surgery, Tokai University School of Medicine, Shiokasuya, Isehara, Kanagawa, Japan.
Sotaro
S
Sadahiro
Department of Surgery, Tokai University School of Medicine, Shiokasuya, Isehara, Kanagawa, Japan.
Toshiyuki
T
Suzuki
Department of Surgery, Tokai University School of Medicine, Shiokasuya, Isehara, Kanagawa, Japan.
Kazutake
K
Okada
Department of Surgery, Tokai University School of Medicine, Shiokasuya, Isehara, Kanagawa, Japan.
Gota
G
Saito
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016687:Polydioxanone; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome
D016687:Polydioxanone