Scar outcomes not improved by closer sutures in wound closure

Closer 1 cm suture spacing when closing wounds does not result in better cosmetic outcomes than 2 cm spacing, new findings show.

Published online in the British Journal of Dermatology, the findings come from a randomized split-wound trial in 50 patients.

In the paper, the authors note that surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial cuticular layer. They note that some surgeons feel that placing many deep sutures will reduce tension on cuticular sutures. This reduced tension would then decrease the incidence of track marks and dehiscence and leading to better cosmetic outcomes. A competing view is that more subcuticular sutures raise the risk of a reaction to the sutures, patient anxiety, and poorer wound outcomes.

To test whether suture spacing had an impact on cosmetic outcomes, in each of the 50 patients in the trial the researchers repaired half of the wound with sutures spaced 2 cm apart and the other half with sutures spaced 1 cm apart.

Two observers and the patients themselves evaluated the scar three months after the surgery using the Patient and Observer Scar Assessment Scale (POSAS). Evaluators and patients were both blinded as to which side received which treatment.

The researchers observed no significant difference at three months in the total mean POSAS score for observers for the sides that received 1 cm and 2cm interval subcuticular sutures. There was also no significant difference between the sides in the patient assessment.

"We found that 1 cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2 cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval," the authors write.

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