Postoperative Outcomes of Absorbable versus Nonabsorbable Sutures in Trigger Finger Release Closure: A Systematic Review and Meta-analysis

Abstract

Background:

Surgical release is an effective treatment for refractory cases of trigger finger; however, the optimal suture material for skin closure remains unclear. This systematic review and meta-analysis compares postoperative outcomes of absorbable versus nonabsorbable sutures following trigger finger (TF) release.

Methods:

This systematic review followed PRISMA guidelines, including a total of 5 studies in the final analysis, comparing absorbable versus nonabsorbable sutures in TF release. Data extraction included suture type, and reported outcomes such as wound complications, functional outcomes, and patient satisfaction. A meta-analysis was performed using RevMan 5.3, with statistical significance set at a P value less than 0.05.

Results:

Patients who received nonabsorbable sutures had significantly higher odds of wound dehiscence, which was analyzed as a specific wound complication (odds ratio [OR]: 2.83, P = 0.02). Nonabsorbable sutures were also associated with higher odds of surgical site infection (OR: 1.49) and postoperative antibiotic use (OR: 1.17); however, these differences were not statistically significant (P = 0.29 and P = 0.74, respectively). In contrast, overall wound complications, analyzed as a composite outcome, were significantly less frequent with nonabsorbable sutures on sensitivity analysis (OR: 0.42, P = 0.004).

Conclusions:

Nonabsorbable sutures were associated with a higher risk of wound dehiscence, whereas they demonstrated a lower rate of overall wound complications in sensitivity analysis following TF release surgery. These findings highlight differences between individual wound outcomes; however, the available evidence remains limited. Further high-quality studies are required to confirm these results and guide optimal suture selection.

Takeaways

Question: What is the preferable suture choice for wound closure in trigger finger release surgery?

Findings: This systematic review and meta-analysis included five studies comparing absorbable versus nonabsorbable sutures for trigger finger release closure. The results showed more wound complications with absorbable sutures, favoring the use of nonabsorbable sutures.

Meaning: Nonabsorbable sutures are preferred for trigger finger release closure, as they are associated with fewer wound complications.

INTRODUCTION

Trigger finger is a common condition of the hand that frequently requires surgical intervention when conservative management fails.¹ Open release of the A1 pulley is a widely performed procedure with high success rates and predictable symptom relief.^2,3 Although the procedure is considered minor, postoperative wound-related complications such as infection, dehiscence, delayed healing, and patient dissatisfaction remain clinically relevant, particularly in procedures involving palmar incisions.^4–6

The palmar skin presents unique challenges for wound healing due to its thickness, constant exposure to moisture, and repetitive mechanical stress during hand use.^7–9 These factors may influence the integrity of surgical wounds and contribute to postoperative complications even after uncomplicated procedures.⁷ As a result, the choice of suture material for skin closure plays an important role in optimizing wound healing and patient outcomes following hand surgery.^10–12

Both absorbable and nonabsorbable sutures are commonly used for skin closure following trigger finger release. Nonabsorbable sutures have traditionally been favored because of their tensile strength and perceived ability to maintain wound approximation under stress.¹³ However, they require suture removal, which may increase patient discomfort, necessitate additional clinic visits, and potentially affect satisfaction.^14–16 In contrast, absorbable sutures eliminate the need for removal and may improve convenience, but concerns persist regarding local inflammatory response, suture extrusion, and wound integrity.^17–19

Previous studies comparing absorbable and nonabsorbable sutures in hand surgery showed inconsistent results. Some studies have reported comparable rates of infection and wound complications between suture types, whereas others have suggested material-specific differences in healing and complication profiles.^20–22 Importantly, evidence specific to trigger finger release remains limited, and existing studies are often underpowered or heterogeneous in design, outcome definitions, and suture materials used.²³ As a result, suture selection in trigger finger release continues to be largely guided by surgeon preference rather than clear evidence.

In this systematic review and meta-analysis, we aim to compare postoperative outcomes following trigger finger release using absorbable versus nonabsorbable sutures for skin closure, with a focus on wound dehiscence, infection, antibiotic use, and overall wound-related complications.

METHODS

Registration and Reporting

This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42024509528). It is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Literature Search Strategy

A comprehensive literature search was conducted in the PubMed and Cochrane databases with no timeline restrictions. The search strategy combined medical subject headings (MeSH) and free-text words related to the concepts of “trigger finger” and “stenosing tenosynovitis”; management terms like “treatment,” “surgery,” “release,” “trigger finger release,” “TFR,” and “A1 pulley release”; and suturing-related terms like “suture,” “absorbable,” “non-absorbable,” and “wound.” An example search strategy for PubMed is provided: (“trigger finger” OR “stenosing tenosynovitis”) AND (treatment OR surgery OR release OR “trigger finger release” OR TFR OR “A1 pulley”) AND (suture OR “absorbable suture” OR “non-absorbable” suture OR wound).

Screening and Selection of Studies

Search results were uploaded to Rayyan.ai to facilitate screening. Rayyan’s AI-assisted features were used to accelerate keyword detection, suggest potential inclusion/exclusion decisions, and support duplicate identification. Initially, 6 independent reviewers screened all titles and abstracts, and conflicts were resolved by a seventh reviewer. Full texts of all potentially eligible studies were retrieved and independently assessed for eligibility by the same 6 reviewers. The reasons for the exclusion of studies during the full-text review phase were documented. Any identified duplicate studies were removed using Rayyan’s AI deduplication features. The complete study selection process is summarized in the PRISMA flow diagram in Figure 1.

Fig. 1.

PRISMA flow diagram illustrating the systematic review process. The diagram outlines the number of records identified, screened, excluded, assessed for eligibility, and included in the final meta-analysis.

Study Eligibility Criteria

This review included randomized controlled trials, cohort studies, case-control studies, case reports, and prospective or retrospective observational studies published in the English language, without any time restrictions, that reported on adult human participants diagnosed with trigger finger, management by surgical release with the type of suturing (comparative studies, which compared both sutures types), and postoperative outcomes reported. Some of the included studies also reported cases of carpal tunnel release in addition to trigger finger surgery; only outcomes related to trigger finger were considered.

Studies were excluded if they included patients younger than 18 years of age; did not report any relevant outcome of interest related to diagnosis, treatment, or patient outcomes; were review articles, editorials, commentaries, or letters; were published in languages other than English; included traumatic injuries, cadaveric studies, or animal models; demonstrated a high risk of bias or low quality based on assessment criteria; or were duplicate publications of the same study.

Data Extraction

A standardized data extraction form was used. Data extraction was independently performed by 2 reviewers. Any discrepancies were resolved through discussion and, when necessary, consultation with a third senior reviewer. The extracted data included study characteristics (authors, year of publication, country, study design, sample size, and study period); patient characteristics (age, sex, and comorbidities); type of sutures applied (absorbable or nonabsorbable); reported outcomes (pain scores, functional outcomes, range of motion, patient satisfaction, recurrence rates, and wound complications); statistical methods used for data analysis; reported effect estimates with confidence intervals (CIs); study conclusions; limitations; and recommendations provided by the authors.

Quality Assessment and Risk of Bias

Quality assessment was conducted independently by 2 reviewers. Any disagreements between the reviewers were resolved through discussion until consensus was reached.

For observational studies, the Newcastle-Ottawa Scale was used to evaluate the risk of bias across 4 domains: selection of study groups, comparability of groups, ascertainment of exposure/outcome, and outcome assessment (details are available in Table 1). For randomized controlled trials, the ROB II tool was used to evaluate the risk of bias across 5 domains: bias arising from the randomization process, bias due to deviations from intended intervention, bias due to missing outcome data, bias in the measurement of the outcome, and bias in the selection of the reported result (Fig. 2).

Table 1.

Observational Studies by Newcastle-Ottawa Scale

Study ID	Selection	Comparability	Outcome	Total Score
Bridges, Kasper, Sherman, Matzon & Ilyas16	3		3	6 (moderate quality)
Kortlever et al24	3		2	5 (moderate quality)
Rochlin, Sheckter & Curtin12	3		2	5 (moderate quality)
Holbert, Brown, Baxter, Johnson, Gelfand, Shushan, Turcotte & Jones17	3		2	5 (moderate quality)

Fig. 2.

Risk of bias assessment of included RCTs using the ROB 2 tool. Each study is evaluated across 5 domains: D1 (randomization process); D2 (deviations from intended intervention); D3 (missing outcome data); D4 (measurement of the outcome); and D5 (selection of the reported result). Green dots indicate low risk of bias, yellow indicates some concerns. The overall risk reflects the highest risk identified across domains. RCT, randomized controlled trial.

Statistical Analysis

Meta-analysis was performed using Cochrane Review Manager (RevMan) version 5.3. For dichotomous outcomes, pooled odds ratios (ORs) with 95% CIs were calculated. For continuous outcomes, mean differences with 95% CI were used. A random-effects model was applied to account for between-study variability.

Each study was weighted using the inverse-variance method, whereby studies with larger sample sizes and smaller standard errors contributed greater weight to the pooled effect estimates. Statistical heterogeneity was assessed using the I² statistical test and interpreted according to the Cochrane Handbook as follows: 0%–40% (low heterogeneity), 30%–60% (moderate heterogeneity), and 50%–90% (substantial heterogeneity). A leave-one-out sensitivity analysis was performed to explore potential sources of heterogeneity.

RESULTS

Characteristics of Included Studies

Five articles comparing absorbable and nonabsorbable sutures were included in our study. Summary characteristics of the included studies are reported in Table 2, and the baseline features are outlined in Table 3.

Table 2.

Summary of Characteristics of Included Studies

ID	Primary Outcome
Rochlin, Sheckter & Curtin12	Incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012).
Bridges, Kasper, Sherman, Matzon & Ilyas16	The “suture” group had significantly more total postoperative visits (185 vs 42, respectively, P < 0.001) and postoperative visits within the first 2 wk (155 vs 10, respectively, P < 0.001) than the “glue” group. Postoperative visits beyond 2 wk of surgery were similar between the two groups. Three patients in the “suture” group and 2 patients in the “glue” group developed a superficial surgical site infection within 30 d after surgery.
Kortlever et al24	(1) Overall satisfaction with care was unrelated to suture type; (2) satisfaction with initial wound healing and appearance was lower among people with no other comorbidities, but unrelated to suture type; (3) there were no factors independently associated with pain intensity; and (4) excisional biopsy was associated with greater activity tolerance.
Holbert et al.17	Patients who did not undergo in-office follow-up were more likely to experience residual stiffness or contracture (11.4% vs. 4.1%; P = 0.033) but had no significant differences in 30-d reoperation, emergency department returns, wound complaints, and Quick DASH scores. Patients with absorbable sutures were significantly more likely to have telemedicine visits but were also more likely to have wound complaints (17.9% vs 8.5%; P = 0.022).
Kim25	Complication rates were higher in the nonabsorbable suture group, but the difference was not statistically significant. Notably, 1 case in the absorbable suture group had uncontrolled postoperative bleeding and required reoperation

Table 3.

Baseline of the Included Studies

Study	Absorbable Suture Type	Absorbable Suture Size	Nonabsorbable Suture Type	Nonabsorbable Suture Size	Sample Size (Absorbable/Nonabsorbable)
Bridges et al16	Monocryl (Poliglecaprone 25)—monofilament	4-0	Prolene (Polypropylene)—monofilament	4-0	150/155
Holbert et al17	Chromic gut—braided/natural	4-0	Nylon—monofilament	4-0	106/223
Kim et al25	Vicryl Rapide (Polyglactin 910)—braided/synthetic	4-0	Ethilon (Nylon)—monofilament	4-0	18/23
Nemirov et al18	Monocryl (Poligecaprone)—monofilament	4-0	Nylon–monofilament	4-0	455/412
Rochlin et al12	Monocryl (Poligecaprone 25)—monofilament and chromic gut—braided/natural	4-0 and 4-0	Nylon (Ethilon)—monofilament	4-0	Monocryl: 188 Chromic: 29 Nylon: 95

Postoperative Outcomes

Dehiscence

The pooled results showed that patients who received Nonabsorbable sutures had a higher odds of dehiscence compared with those who received absorbable sutures (OR: 2.83 [1.20, 6.67] with 95% CI; P = 0.02; Fig. 3). The sensitivity analysis revealed no heterogeneity (I² = 0%, P = 0.69). The funnel plot of dehiscence is shown in Supplemental Digital Content 1. (See figure, Supplemental Digital Content 1, which displays the funnel plot assessing publication bias for postoperative wound dehiscence. The symmetry of the plot reflects the likelihood of publication bias among included studies reporting this outcome, https://links.lww.com/PRSGO/F8.)

Fig. 3.

Forest plot comparing postoperative dehiscence between absorbable and nonabsorbable suture. The pooled MD, CI, and study weights are displayed. MD, mean difference.

Infection

The pooled analysis showed an odds ratio of 1.49 (95% CI: 0.71–3.16) for infection in the nonabsorbable suture group compared with the absorbable suture group; however, this difference was not statistically significant (P = 0.29) (Fig. 4). The sensitivity analysis revealed no heterogeneity (I² = 0%, P = 0.49). The funnel plot of infection is shown in Supplemental Digital Content 2. (See figure, Supplemental Digital Content 2, which displays the funnel plot assessing publication bias for postoperative infection outcomes. Plot symmetry suggests absence of publication bias, whereas noticeable asymmetry could indicate selective reporting, https://links.lww.com/PRSGO/F9.)

Fig. 4.

Forest plot comparing postoperative infection between absorbable and nonabsorbable suture. The pooled MD), CI, and study weights are displayed. MD, mean difference.

Antibiotics

The pooled analysis comparing the need of antibiotics among nonabsorbable sutures, and absorbable sutures had an OR (1.17 [0.47, 2.91] with 95% CI). However, the results were not statistically significant (P = 0.74) (Fig. 5). The sensitivity analysis revealed moderate heterogeneity (I² = 27%, P = 0.26), which decreased after omitting Kortlever et al by the leave-one-out test (I² = 0%), with no statistically significant difference (OR: 1.72 [0.69, 4.31] with 95% CI, P = 0.24; Fig. 6). The funnel plot of satisfaction rate is shown in Supplemental Digital Content 3. (See figure, Supplemental Digital Content 3, which displays the funnel plot assessing publication bias for postoperative antibiotic use. The symmetry or asymmetry of the plot indicates the likelihood of reporting or selection bias across included studies, https://links.lww.com/PRSGO/F10.)

Fig. 5.

Forest plot comparing postoperative antibiotic use between absorbable and nonabsorbable suture. The pooled MD, CI, and study weights are displayed. MD, mean difference.

Fig. 6.

Sensitivity analysis of postoperative antibiotic use. Heterogeneity was resolved after excluding the study by Kortlever et al. The forest plot displays ORs, 95% CIs, and study weights.

Wound Problems

In this meta-analysis, wound problems refer to superficial wound complications (eg, seroma, hematoma, superficial surgical site infection, delayed healing), which are distinct from wound dehiscence.

The pooled results reveled that patients in the nonabsorbable sutures group had lower odds of wound problems compared to the absorbable sutures group (OR: 0.76 [0.22, 2.57] with 95% CI). However, the results were not statistically significant (P = 0.66; Fig. 7). The sensitivity analysis revealed substantial heterogeneity (I² = 84%, P = 0.0003), which decreased after omitting Rochlin et al by the leave-one-out test (I² = 0%), with a statistically significant difference (OR: 0.42 [0.23, 0.76] with 95% CI, P = 0.004) (Fig. 8). Importantly, this finding emerged only after sensitivity analysis and should therefore be interpreted as hypothesis-generating rather than definitive. The funnel plot of wound problems is shown in Supplemental Digital Content 4. (See figure, Supplemental Digital Content 4, which displays the funnel plot assessing publication bias for postoperative wound problems. Visual inspection of the plot indicates whether there is symmetry, suggesting lack of bias, or asymmetry that may reflect potential publication bias, https://links.lww.com/PRSGO/F11.)

Fig. 7.

Forest plot comparing postoperative wound problems between absorbable and nonabsorbable suture. The pooled MD, CI, and study weights are displayed. MD, mean difference.

Fig. 8.

Sensitivity analysis of postoperative wound problems. Substantial heterogeneity was resolved after excluding Rochlin, et al.¹² The forest plot presents ORs, 95% CIs, and study weights.

DISCUSSION

The pooled results of our study demonstrated that patients with nonabsorbable sutures had significantly higher odds of wound dehiscence than those with absorbable sutures (OR: 2.83 [95% CI: 1.20–6.67], P = 0.02). Sensitivity analysis revealed no heterogeneity (I² = 0%, P = 0.69), indicating consistency across included studies. However, Kim et al²⁵ reported no statistically significant differences in the overall complication rates between absorbable and nonabsorbable sutures (P = 0.572). Superficial dehiscence was observed in both groups and was attributed to postoperative activities such as gripping.²⁵ Similarly, Erel et al found no significant differences in the wound dehiscence rates between polyglactin 910 and nylon sutures, with only 2 cases of dehiscence reported in each group, but suture extrusion was more common in the absorbable suture group.²⁶ In contrast, Rochlin observed that incisions closed with Monocryl sutures were significantly less likely to develop dehiscence (P = 0.006).¹²

However, when comparing rates of infection, the pooled results demonstrated that patients with nonabsorbable sutures had a higher odds ratio (OR = 1.49) of developing infections than those with absorbable sutures, but this finding was not statistically significant (P = 0.29). The sensitivity analysis revealed no heterogeneity (I² = 0%, P = 0.49), indicating consistency across the included studies. These findings go against some of the published literature; for instance, Rochlin et al found that incisions closed with Monocryl [poliglecaprone 25] were significantly less likely to develop infections when compared with nylon and chromic sutures (infection rates: Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003),¹² it is worth noting that a high infection rate in the chromic suture group—which is an absorbable suture—suggests that differences among individual absorbable materials may exist and could influence postoperative outcomes. In contrast, Theopold et al and Tzimas et al reported no significant differences in infection rates between absorbable and nonabsorbable sutures after carpal tunnel release procedures.^14,15

In addition, the relationship between suture type and antibiotic use was assessed, and nonabsorbable sutures were associated with higher odds of requiring antibiotics (OR: 1.17 [0.47, 2.91]), although the results were not statistically significant (P = 0.74). Sensitivity analysis revealed moderate heterogeneity (I² = 27), which decreased to zero after omitting a single study, but the odds ratio remained statistically insignificant (OR: 1.72 [0.69, 4.31]; (P = 0.24). These findings align with Rochlin et al, who observed fewer infections and high antibiotic use with nonabsorbable sutures than with absorbable sutures.¹² On the other hand, Holbert et al reported more complications with absorbable sutures than with nonabsorbable, although the statistical significance was borderline (P = 0.06).¹⁷ These findings challenge Nemirov et al, who reported no significant difference in antibiotic use between absorbable and nonabsorbable sutures.¹⁸

When assessing the difference between absorbable and nonabsorbable sutures in the context of wound closure, the pooled analysis indicated that nonabsorbable sutures were associated with lower odds of wound problems when compared with absorbable sutures, but the results were not statistically significant (P = 0.66) and showed substantial heterogeneity (I² = 84%). Sensitivity analysis reduced heterogeneity (I² = 0%) and demonstrated a statistically significant difference favoring nonabsorbable sutures after omitting 1 study (P = 0.004). In contrast, Kim et al reported no statistically significant differences in the overall complication rates (P = 0.572), although specific complications such as tenderness and reoperation were noted in both groups.²⁵ Similarly, Bridges et al found comparable rates of wound complications between suture types, suggesting that there were no differences between the suture types.¹⁶

CONCLUSIONS

Our systematic review and meta-analysis found that Nonabsorbable sutures were associated with a significantly higher risk of wound dehiscence following trigger finger release. Overall, nonabsorbable sutures were associated with fewer wound problems (seroma, hematoma, superficial surgical site infection, and delayed wound healing), suggesting they may offer advantages in reducing such complications. Additionally, nonabsorbable sutures were responsible for fewer overall wound problems with statistical significance emerging after sensitivity analysis. These findings suggest that, although both suture types are viable for skin closure, nonabsorbable sutures may offer advantages in reducing certain wound problems. Further high-quality studies are required to confirm these results and guide optimal suture selection in trigger finger release surgery.

LIMITATIONS AND RECOMMENDATIONS

This meta-analysis has several important limitations that must be acknowledged when interpreting our findings. First, the most significant limitation is the substantial variability in suture material and technique across the studies. They have different properties and tissue reactions. Furthermore, variations in incision orientation may subject wounds to different mechanical forces during healing, potentially influencing dehiscence rates independent of suture type. On the other hand, although all studies included the same size of suture (4-0), this suture size may inherently increase inflammatory complications. Second, the analysis focused extensively on short-term clinical outcomes within the first 30–60 days postoperatively. We did not capture patient reported outcomes such as satisfaction with wound healing, pain scores during the healing period, scar cosmesis, or the convenience and discomfort associated with suture removal for nonabsorbable sutures. Finally, the small number of included studies (n = 5) and varying methodological quality and design limits both the statistical analysis and generalizability of our findings.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

Supplementary Material

gox-14-e7880-s001.pdf ^{(150.4KB, pdf)}

gox-14-e7880-s002.pdf ^{(153.5KB, pdf)}

gox-14-e7880-s003.pdf ^{(145.4KB, pdf)}

gox-14-e7880-s004.pdf ^{(187.7KB, pdf)}