A Comparison of Polyglactin 910 and Chromic Gut Suture in the Closure of Punch Biopsy Sites

Purpose of the Study This study will seek to compare two absorbable suture materials (PDS and chromic gut) in the closure of punch biopsy sites. This information could contribute to cost savings and increased convenience for patients.

Background A punch biopsy is a full thickness skin biopsy performed by Dermatologists to diagnose various skin conditions. The incision from the biopsy ranges from 2 - 6mm in width2. There have been several recommendations of ways to manage these biopsy sites including the use of a non-absorbable suture such as nylon, healing by second intention and the use of an absorbable suture such as PDS or Polyglactin 9101,3. The benefit of an absorbable suture over a non-absorbable suture is reduced costs to the patient because they will not have pay for a suture removal visit. Also, the patients do not have the extra inconvenience of returning to the clinic a second time2,3. There has been only one case in the literature comparing an absorbable with a non-absorbable suture material in the closure of skin punch biopsy sites2. Never, has there been a study comparing two different absorbable suture in this setting. We believe there may be a less expensive suture material that would yield the same performance as the current ones. If this is the case, this information could benefit the Dermatology community in that it would provide a less expensive alternative suture material to close skin punch biopsy sites. Therefore, it would cut overall costs related to this routine procedure.

Chromic gut is an absorbable suture made from natural fibers of sheep or cattle intestine. It is one of the first absorbable sutures available and is inexpensive. The difference between plain gut and chromic gut is chromic gut is treated with chromic salts which allows it to retain its tensile strength longer. The suture integrity lasts 10-14 days (time at when the suture begins the absorption process) with complete absorption in 15-60 days. Chromic gut is documented to have moderate to high tissue reactivity4,5.

PDS is an absorbable, monofilament made from synthetic material (polyester). It is a newer, more expensive, absorbable suture material. The suture integrity lasts 45-60 days with total absorption in 180 days. PDS is documented to have low tissue reactivity and is shown to maintain its tensile strength in the presence of a bacterial infection4,5.

Performance of PDS with chromic gut suture in closing of punch biopsy sites would be compared in this study. We hope that the information that we collect could show that the less expensive suture (chromic gut) can be safely used in closing skin punch biopsy sites, therefore improving the clinical practice of these procedures and saving the health care system money.