Skin closure is a critical component of surgical wound healing. Despite advancements in suture materials and techniques, wound-related complications continue to pose significant challenges in postoperative recovery1,2. The primary objective of suturing is to approximate the wound edges effectively, minimizing tissue trauma and promoting faster healing3. However, several complications such as wound infection, dehiscence, hypertrophic scarring, and delayed healing have been reported4.

The incidence of surgical site infection (SSI) varies from 2% to 20% depending on the procedure and patient factors5. Sutures, being foreign bodies, can harbor microorganisms and contribute to infection6. The material used, whether absorbable or non-absorbable, as well as the suturing technique (interrupted vs. continuous), influences the healing outcome7. Additionally, patient-related factors such as diabetes mellitus, malnutrition, and smoking may impair wound healing and predispose to complications8,9.

Complications not only increase morbidity and cost but also necessitate secondary interventions, thereby extending hospital stay10. Studies have compared different suture materials like nylon, polypropylene, and polyglactin in various contexts, suggesting varied outcomes in terms of infection rate and scar formation11,12. The choice of suture and technique must therefore be individualized based on wound type, location, and patient profile13.

Prospective studies on wound-related complications specific to suture methods remain limited in the Indian context. This study aims to fill that gap by systematically analyzing complications related to skin sutures in a diverse patient population. By documenting complication rates and correlating them with suture choices and patient profiles, this study seeks to provide evidence-based recommendations to minimize postoperative morbidity.

A prospective observational study was conducted over 12 months in the General Surgery department of a tertiary care teaching hospital in South India.

Sample Size and Population:

A total of 250 patients undergoing elective surgeries requiring skin sutures were included using consecutive sampling.

Inclusion Criteria:

• Patients aged 18–70 years
• Undergoing clean or clean-contaminated surgical procedures
• Willing to provide written informed consent

Exclusion Criteria:

• Emergency surgeries
• Known immunodeficiency
• Chronic steroid use
• Poor nutritional status (BMI <18)
• Uncontrolled diabetes mellitus (HbA1c >8.5%)

Suturing Techniques and Materials:

Standard surgical protocols were followed. Suture materials included absorbable (polyglactin) and non-absorbable (nylon, polypropylene) options. Techniques included simple interrupted, vertical mattress, and subcuticular methods.

Data Collection:

Preoperative data (age, sex, comorbidities), intraoperative findings (suture material and technique), and postoperative wound outcomes were recorded. Follow-up was conducted on postoperative days 3, 7, 14, and 30 to assess for complications:

• Wound infection (based on CDC criteria)
• Dehiscence
• Hypertrophic scarring

Statistical Analysis:

Data were analyzed using SPSS v25. Descriptive statistics were used for baseline variables. Chi-square test and logistic regression were applied to determine associations between complications and variables like suture type and technique. A p-value <0.05 was considered significant.

Table 1: Demographic Characteristics

In table 1, the study cohort consisted of 250 patients, with a slight male predominance (56.8%). Nearly half of the participants were under 40 years of age, suggesting a relatively young and active population.

Table 2: Comorbidities

In table 2, among the studied population, hypertension (24.8%) and diabetes (18.0%) were the most common comorbidities. Smoking, present in 20%, also negatively impacts collagen synthesis and tissue oxygenation.

Table 3: Type of Suture Material Used

In table 3, Non-absorbable sutures (nylon and polypropylene) were more frequently used (74%) compared to absorbable sutures (polyglactin, 26%).

Table 4: Suturing Techniques

In table 4, Simple interrupted sutures were the most commonly used (56%), followed by vertical mattress (28%) and subcuticular techniques (16%).

Table 5: Incidence of Complications

In table 5, The total wound-related complication rate was 16%, with infection (10%) being the most common. This aligns with established infection rates in clean-contaminated surgeries. Dehiscence occurred in 4% of patients and was often associated with poorly controlled diabetes or technical issues such as improper tension. Hypertrophic scars were seen in only 2%, suggesting that cosmetic outcomes were generally satisfactory.

Table 6: Association Between Technique and Complication

In table 6, The vertical mattress technique was associated with the highest infection rate (14.3%) and dehiscence (7.1%), likely due to deeper dermal penetration and greater suture tension.

Our study identified a 16% overall complication rate following skin suturing in elective surgeries, which aligns with similar studies that reported rates between 10% and 20%14,15. Wound infection emerged as the most common complication, consistent with prior findings by Cruse and Foord16 and Mangram et al17. The increased infection rate with vertical mattress sutures could be attributed to more tissue handling and tension at the wound margins.

Non-absorbable sutures, particularly nylon, were associated with a higher incidence of infection and scarring, corroborating previous reports by Rodeheaver et al18. Polyglactin (Vicryl), an absorbable suture, demonstrated better outcomes in terms of reduced infection and favorable cosmetic healing, a finding supported by Chu et al19.

Dehiscence occurred more frequently in patients with comorbidities such as diabetes and hypertension, reaffirming the role of systemic health in wound healing20,21. While our study excluded severely immunocompromised patients, even moderate metabolic disturbances appeared to impact healing outcomes.

Subcuticular suturing, although used less frequently, showed the lowest complication rates, supporting earlier observations by Moy et al22 and suggesting its utility in patients where aesthetics and reduced infection risk are priorities.

Studies by Katz23 and Edlich et al24 support the notion that minimal tissue handling, monofilament sutures, and timely suture removal are key to minimizing complications. Our study reinforces these principles while adding prospective Indian data to the global literature.

Limitations include the short follow-up period (30 days), lack of long-term scar assessment, and potential observer bias in complication identification.

Wound-related complications of skin sutures are significantly influenced by the choice of suture material and technique. Vertical mattress techniques and non-absorbable sutures showed a higher risk of complications. Patient comorbidities also contribute to delayed healing. Adoption of subcuticular techniques and absorbable sutures may improve outcomes, particularly in high-risk patients. Tailored approaches based on patient and surgical factors are essential to reduce morbidity and enhance recovery.

1. Moy RL, Lee A, Zalka A. Commonly used suture materials in skin surgery. Am Fam Physician. 1991;44(6):2123–8.
2. Edlich RF, Rodeheaver GT, Thacker JG. Surgical wound closure. Ann Emerg Med. 1983;12(8):497–500.
3. Katz S. Suturing techniques in skin surgery. J Dermatol Surg Oncol. 1985;11(12):1106–10.
4. Rodeheaver GT. Wound healing and suture material. Surg Clin North Am. 1984;64(4):657–70.
5. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20(4):250–78.
6. Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60(1):27–40.
7. Chu CC. Mechanical properties of suture materials: an important characterization. Ann Surg. 1981;193(3):365–71.
8. Polk HC Jr. Postoperative infections: a critical appraisal. Am J Surg. 1981;141(3):358–65.
9. Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30(1):37–45.
10. Leaper DJ. Appropriate use of antibiotics in surgical practice. Ann R Coll Surg Engl. 1995;77(6):447–9.
11. Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63(11):873–6.
12. Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis. 2001;7(2):220–4.
13. Törmä H. Suture techniques and wound healing. Scand J Surg. 1999;88(3):147–9.
14. Mangram AJ, et al. Guideline for prevention of surgical site infection. Infect Control. 1999;20:250.
15. Alexander JW. Wound infection. Dis Colon Rectum. 1985;28(11):804–9.
16. Cruse PJ, Foord R. Wound infection surveillance. J Hosp Infect. 1983;4(4):377–85.
17. Horan TC, et al. CDC definitions of nosocomial surgical site infections. Am J Infect Control. 1992;20(5):271–4.
18. Rodeheaver GT, et al. Influence of suture materials on wound infection. Arch Surg. 1981;116(10):1308–14.
19. Chu CC, Williams DF. Effects of physical configuration and chemical structure of sutures on bacterial adhesion. J Biomed Mater Res. 1984;18(7):845–63.
20. Altemeier WA, et al. Manual on Control of Infection in Surgical Patients. 2nd ed. Philadelphia: Saunders; 1984.
21. Armstrong DG, et al. Clinical implications of wound infection in diabetes. Clin Infect Dis. 1995;21(Suppl 2):S105–10.
22. Moy RL, et al. Aesthetic closure techniques. Dermatol Clin. 1993;11(2):371–81.
23. Katz S. Suturing for plastic and reconstructive surgery. Surg Clin North Am. 1978;58(5):999–1008.
24. Edlich RF, et al. Principles of emergency wound management. Ann Emerg Med. 1982;11(3):135–40.