DALLAS — Hydrogen peroxide is commonly used to clean and prep wounds in a surgical setting, but as a recent study demonstrates, its use on absorbable gut sutures significantly decreases their tensile strength and causes premature suture degradation, likely leading to wound dehiscence and, possibly, hypertrophic scarring.
HYDROGEN PEROXIDE AS AGGRESSOR The study results showed that there was a significant decrease in the tensile strength of the fast-absorbing gut sutures treated with hydrogen peroxide compared to those treated with water and those in the control group. "These results are definitely an eye-opener for any surgeon who readily uses hydrogen peroxide in standard wound treatment," Dr. Athre tells Cosmetic Surgery Times. "One of the major endpoints of a given surgery is the cosmetic outcome of the surgery itself. In our day and age, patients and physicians alike expect and demand a maximum aesthetic result of any surgical procedure undertaken. As our study results clearly showed, sutures that are treated with hydrogen peroxide will degrade prematurely. This will inevitably cause a tearing of the sutures and will very likely lead to wound dehiscence — a very much unwanted post-surgical complication, aesthetically speaking. Wound dehiscence will, more often than not, lead to hypertrophic scarring and possibly even keloid formation."In the study, 15 samples of 5-0 fast-absorbing gut, 5-0 nylon, and 5-0 prolene sutures were randomized and tested for their tensile strength. For each type of suture, five samples were randomized to a control group, five sutures were treated with distilled water, and five sutures were treated with three percent hydrogen peroxide. The water- or hydrogen peroxide-treated sutures were dipped into the appropriate solution twice a day, for five minutes at each trial, for a total of five days. At the end of the five-day trial, all of the sutures were subjected to the In-Spec 2200 portable bench-top tester. "We noticed that the nylon and prolene sutures were not affected at all by the water or the hydrogen peroxide treatments," Dr. Athre relates. "These sutures retained their shape, color and general feel upon inspection. However, the effect on the fast-absorbing gut sutures was very much different. The fast-absorbing gut sutures exposed to water remained unaffected, but those exposed to hydrogen peroxide rinses completely disintegrated when handling the suture. The sutures could not hold any tension at all. In one case, the suture had completely degraded and the only remnant of the suture was the needle." Dr. Athre says that creating a cosmetically appealing scar that does not affect form and function is one of the important endpoints of a surgical procedure. He adds that complications such as wound infection, wound dehiscence, hypertrophic scarring and contractures may all result from improper closure techniques, improper wound-care regimens — as well as patient factors such as nutritional status and medical comorbidities. FUNDAMENTAL CHANGE IN THOUGHT According to Dr. Athre, standard superficial wound-care regimens include water, soapy water, bacitracin ointment, bactroban, hydrogen peroxide and Dakin's solution, or any combination of these. Because of this range of options, he advises, surgeons should give specific instructions to patients for home care, strongly advising them to avoid use hydrogen peroxide, and to select saline or soap and water for wound cleaning instead. "For years, patients have gotten used to the fact that hydrogen peroxide is beneficial to wound healing," Dr. Athre says. "When applied to a wound, it will foam up and, yes, it will effectively clean a cut or a scab; but now it is our job as physicians to tell them not to use it on wounds that were closed with fast-absorbing sutures. Patients must quickly become critically aware and conscious of what kind of suture was used to close their wound. This awareness and appropriate avoidance of hydrogen peroxide will surely prevent unwanted dehiscence and scarring." "The results of our study underscore the importance of the agent used in wound care following a surgery," Dr. Athre says. "We believe that hydrogen peroxide should be avoided as a superficial wound-care regimen where fast-absorbing gut sutures are used." Reference Athre RS, Park J, Leach JL. The effect of a hydrogen peroxide wound care regimen on tensile strength of suture. Arch Facial Plast Surg. 2007;9:281-284.
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