DS01 (P32): An international, prospective cohort study CompAring Non-absorbable Versus Absorbable sutures for Skin surgery: the CANVAS Service Evaluation

Orals

Alice Lee,^1,2 Guy Stanley,³ Ryckie G. Wade,^4,5 Jonathan M. Batchelor,⁶ Rachel A. Abbott,⁷ Matthew D. Gardiner,^8,9 Aaron Wernham^10,11 and David Veitch¹¹

¹Department of Surgery and Cancer, Imperial College London, London, UK; ²Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK; ³Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Australia; ⁴Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK; ⁵Leeds Institute for Medical Research, University of Leeds, Leeds, UK; ⁶Department of Dermatology, Beckenham Beacon, Beckenham, Kent, UK; ⁷Department of Dermatology, Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK; ⁸Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK; ⁹Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; ¹⁰Department of Dermatology, Leicester University Hospitals NHS Trust, Leicester, UK; and ¹¹Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK

There is no consensus on whether absorbable sutures (AS) or non-absorbable sutures (NAS) should be used for epidermal closure following skin lesion excision. Our primary aim was to determine current practice with regard to suture use following excisional skin surgery in the UK, the Republic of Ireland, Australia and New Zealand. We also aimed to identify complications within 30 days of the procedure and any other variation in practice related to excisional skin surgery. An international steering group of dermatologists and plastic surgeons designed the study protocol for a prospective service evaluation of patients undergoing skin lesion excision with epidermal closure. Data collectors were recruited from UK and Australasian collaborator networks, and uploaded data to REDCap© between 1 September 2020 and 15 April 2021. All specialities involved in skin surgery (primary and secondary care) could contribute. Supervising consultants for each unit validated 1–3 randomly selected records for accuracy. Descriptive statistics and multivariable sensitivity analysis were used for analysis. In total, 3494 patients (4066 excisions) were included: 3246 (92·9%) were from the UK and Republic of Ireland. Most patients were male [n = 1945 (55·7%)] and white British [n = 2453 (70·2%)]. The modal age group was 75–85 years [n = 965 (27·6%)]. The most common suspected lesion was basal cell carcinoma [n = 1712 (42·1%)], then squamous cell carcinoma [n = 908 (22·3%)] and melanoma [n = 523 (12·9%)]. Most procedures were performed by dermatologists [n = 1803 (44·3%)], plastic surgeons [n = 1413 (34·8%)] and maxillofacial surgeons [n = 434 (10·7%)]. Most wounds were closed primarily [n = 2856 (82·3%)]; there was equipoise with regard to using AS [n = 2127 (57·7%)] or NAS [n = 1558 (42·3%)] for epidermal closure. Suture type for epidermal closure differed by speciality, with maxillofacial surgeons most commonly using AS (74·7% cases) vs. plastic surgeons (70·9%) and dermatologists (42·7%). Use of NAS was more common in Australia/New Zealand [n = 274 (89·3%)] vs. the UK [n = 1284 (38%)]. The most common documented complications were surgical site infection [n = 103 (2·5%)], delayed wound healing [n = 77 (1·9%)] and wound dehiscence [n = 45 (1·1%)]. The most common skin preparation agent was aqueous chlorhexidine [n = 2138 (61%)]. Antimicrobial skin ointments were used in 13% of cases. In a multivariable sensitivity analysis, after adjusting for patient and other perioperative details, the type of suture (AS vs. NAS, and braided vs. monofilament) was not associated with complications (wound infection, dehiscence, stitch abscess, delayed healing or retained surface suture). Overall, AS were used slightly more frequently than NAS for epidermal closure after excisional skin surgery, with dermatologists more commonly using NAS than plastic surgeons. Current practice with respect to skin preparation agents and antibiotic wound ointments does not follow National Institute for Health and Care Excellence guidance. This study demonstrates significant variability in the choice of epidermal sutures and hence the need for a definitive randomized controlled trial comparing AS and NAS with respect to complications, cosmetic outcome, health economics and patient satisfaction.