How Suture Technique Affects the Cosmetic Outcome of Cutaneous Repairs

August 2014 | Volume 13 | Issue 8 | Original Article | 967 | Copyright © 2014

Thuzar M. Shin MD PhD and Jeremy S. Bordeaux MD MPH

Department of Dermatology, University Hospitals Case Medical Center and
Case Western Reserve University School of Medicine, Cleveland, OH

Abstract

INTRODUCTION: Skin defects can be repaired via primary closure, secondary intention healing, local and distant flaps, skin grafts or application of natural and synthetic skin substitutes. When possible, primary linear repair is favored due to simplicity, minimal morbidity and rapid healing. A number of suture techniques are available to the surgeon for primary closure, the selection of which depends on defect size, anatomic location, wound eversion, and tension.
OBJECTIVE: To review suture techniques and how they influence scar cosmesis.
METHODS: PubMed was searched using the following key words: cosme* in combination with cutaneous suture, simple interrupted, simple running, running locked, vertical mattress, horizontal mattress, buried, subcuticular, running vertical mattress, running horizontal mattress, buried vertical mattress, butterfly suture, or pulley suture. Information on study type, number of patients, age, gender, defect type, anatomic location, suture technique, scar length, follow up, and outcomes measured were tabulated.
RESULTS: Twenty-four articles - 17 prospective randomized controlled trials including 1,473 subjects and 1,608 repairs and seven case series including 465 subjects and repairs - were reviewed. Fifteen articles - 12 randomized controlled trials and three case series - demonstrated that aesthetic outcome was influenced by suture technique, the majority of which showed subcuticular closure to be superior to simple interrupted or simple running sutures. No difference in aesthetic outcome was observed in nine studies, which included 370 repairs.
DISCUSSION: Review of the literature supports the use of subcuticular closure over simple interrupted or simple running sutures on the trunk and extremities for improved aesthetic outcome.

J Drugs Dermatol. 2014;13(8):967-969.

Purchase Original Article

Purchase a single fully formatted PDF of the original manuscript as it was published in the JDD.

Download the original manuscript as it was published in the JDD.

Contact a member of the JDD Sales Team to request a quote or purchase bulk reprints, e-prints or international translation requests.

To get access to JDD's full-text articles and archives, upgrade here.

Save an unformatted copy of this article for on-screen viewing.

Print the full-text of article as it appears on the JDD site.

→ proceed | ↑ close

INTRODUCTION

Skin defects can be repaired via primary closure, secondary intention healing, local and distant flaps, skin grafts, application of natural and synthetic skin substitutes. Linear repair is usually preferred when possible, due to simplicity, minimal morbidity and rapid healing. Methods to aid in primary closure include sutures, staples, adhesives, and tape. A variety of suture techniques have been described, the selection of which depends on several factors, including defect size and anatomic location. Additional considerations include the ability to evert the wound edges in order to leave a fine, linear, imperceptible scar after wound contraction, and the presence of tension on the wound edges, which increases the risk of dehiscence and a poor cosmetic outcome.

METHODS

We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed) using the following key words: cosme* in combination with cutaneous suture, simple interrupted, simple running, running locked, vertical mattress, horizontal mattress, buried, subcuticular, running vertical mattress, running horizontal mattress, buried vertical mattress, butterfly suture, or pulley suture. Relevant citations within the articles retrieved were reviewed. Studies written in English in which suture techniques were compared and cosmetic outcome assessed were included. Review articles without original data, studies that did not compare at least two different suturing techniques, studies that did not evaluate the aesthetic outcome of the scar, and animal studies were excluded. Publications meeting the inclusion criteria were reviewed and information on study type, number of patients, age, gender, defect type, anatomic location, suture technique, scar length, follow up, and outcomes measured were extracted and tabulated.

RESULTS

Twenty-four articles - 17 prospective randomized controlled trials including 1,473 subjects and 1,608 repairs and seven case series including 465 subjects and repairs - were reviewed. The subjects had an average age of 45.9 years in 14 studies, ranged from 18 months to 78 years in seven studies, and was not reported in five studies. Of the 1,638 patients for which gender was reported, 39% were female and 61% were male. Defect types and anatomic locations are listed in Table 1, with abdominal surgery (33.5%), orthopedic surgery (12.4%), laparoscopic or endoscopic port incisions (11.1%), thoracic surgery (9.9%), saphenofemoral ligation (8.9%), and elliptical incisions (8.3%) being the most common. Wound length was available for 10

↑ back to top


Related Articles