Suture Selection to Minimize Postoperative Postinflammatory Hyperpigmentation in Patients With Skin of Color During Mohs Micrographic Surgery
The effects of suture selection on postinflammatory hyperpigmentation (PIH) in patients with skin of color who have had Mohs micrographic surgery (MMS) are limited. During the COVID-19 pandemic, fast-absorbing gut sutures reduced the need for in-person follow-up visits without increasing the frequency of postoperative complications. Although absorbable gut sutures are popular, they are highly reactive and can induce inflammation in patients with skin of color. Choosing less inflammatory, nonabsorbable sutures can improve the cosmetic outcome for patients with skin of color who undergo MMS.
Practice Implications
Although some studies suggest that there are no cosmetic differences between absorbable and nonabsorbable sutures, the effect of suture type in patients with skin of color undergoing MMS often is unreported or is not studied.6,7 The high reactivity and cutaneous inflammation associated with absorbable gut sutures are important considerations in this patient population.
In patients with skin of color undergoing MMS, we use nonabsorbable epidermal sutures such as nylon and Prolene because of their low reactivity and association with favorable aesthetic outcomes. Nonabsorbable sutures can be safely used in patients of all ages who are undergoing MMS under local anesthesia.
An exception would be the use of the absorbable suture Monocryl (J&J MedTech) in patients with skin of color who need a running subcuticular wound closure because it has low tissue reactivity and maintains high tensile strength. Monocryl has been shown to create less-reactive scars, which decreases the risk for keloids.8,9
More clinical studies are needed to assess the increased susceptibility to PIH in patients with skin of color when using absorbable gut sutures.
