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
