Original article
Aesthetic outcome of simple cuticular suture distance from the wound edge on the closure of linear wounds on the head and neck: A randomized evaluator blinded split-wound comparative effect trial

https://doi.org/10.1016/j.jaad.2021.10.036Get rights and content

Background

Little data support the optimal distance of cuticular suture placement from the wound edge to achieve the most cosmetically appealing scar.

Objective

To compare Patient and Observer Scar Assessment Scale (POSAS) scores for cutaneous sutures spaced 2 mm versus 5 mm from the wound edge in head and neck defects repaired via linear closure.

Methods

Fifty patients were enrolled in this randomized, evaluator blinded, split-scar study. Surgical wounds were repaired with cuticular sutures 2 mm from the wound edge on one side and 5 mm on the other. POSAS scores and scar width were compared 3 months postoperatively.

Results

The sum observer POSAS score for this study had a mean (SD) of 16.06 (6.49) on the 2-mm side and 15.82 (6.83) on the 5-mm side (P = .807). Similarly, no difference was seen between scar width with a mean (SD) of 0.100 cm (0.058 cm) on the 2-mm side and with mean (SD) 0.100 cm (0.076 cm) on the 5-mm side (P = .967).

Limitations

Linear repairs were studied on head and neck defects after extirpation of cutaneous malignancies, resulting in a homogeneous elderly white patient population.

Conclusion

Cuticular sutures placed 2 or 5 mm from the wound edge did not result in different cosmetic outcomes in linear closures on the head and neck.

Section snippets

Methods

This single-center, randomized, dual evaluator blinded, split-wound study was conducted at the UC Davis dermatology clinic from December 19, 2019, to November 6, 2020 (Fig 1, ClinicalTrials.gov Identifier: NCT04870008). Ethical approval was obtained through the UC Davis Institutional Review Board before study commencement, and all patients provided verbal and written informed consent to enrollment. Patients 18 years of age or older who could give informed consent, willing to return for a

Results

Fifty patients were enrolled in the study (Table I). One patient was lost to follow-up. No statistically significant difference in any outcome was seen between sutures placed 2 mm versus 5 mm from the wound edge in our cohort of patients (Table II). No significant difference in the primary outcome measure, the mean sum of the POSAS scores of masked viewers was seen, with a mean (SD) of 16.06 (6.49) on the 2-mm side and 15.82 (6.83) on the 5-mm side (P = .807). Similarly, no significant

Discussion

Suture distance from the wound edge between 2 mm and 5 mm does not directly impact scar outcomes. Although 3 patients had suture reactions on the 2-mm side and none were isolated to the 5-mm side; these reactions were to the dermal sutures and unlikely related to the epidermal suture spacing. The strengths of this study include randomization, blinding of the observers, and objective quantification of scar width using the trace-to-tape method. Moreover, the split-scar model controls for

Conclusion

Epidermal sutures placed 2 or 5 mm from the wound edge failed to demonstrate different cosmetic outcomes on primary linear closures on the head and neck. Surgeons may continue placing sutures at either distance without apparent consequence.

Conflicts of interest

None disclosed.

References (13)

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Cited by (3)

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Funding sources: None.

IRB approval status: Approved by UC Davis IRB.

Reprints not available from the authors.

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