Subcuticular stitching on trunk, extremities resulted in better aesthetic outcomes

ATLANTA — Subcuticular closure was preferred to simple interrupted or simple running sutures on the trunk and extremities for providing improved aesthetic outcomes, according to study data presented at the American Society for Dermatologic Surgery’s annual meeting.

Researchers searched PubMed using the keywords “cosme*” in combination with “cutaneous suture, simple interrupted, simple running, running locked, vertical mattress, running horizontal mattress, buried vertical mattress, butterfly suture” or “pulley suture” and reviewed relevant citations within the articles. Studies included suture technique comparisons and cosmetic outcome assessments. Researchers tabulated study types, number of patients, age, gender, defect type, anatomic location, suture technique, scar length, follow-up and outcome measures.

Of 24 articles reviewed (17 prospective randomized control trials and seven case series), there were 2,073 repairs (94.4%, trunk and extremities; 5.6% face) and 1,938 patients. Gender was reported for 1,638 patients (61% men). Abdominal surgery was the most reported defect (35.7%), followed by orthopedic (12.4%) and laparoscopic/endoscopic port incision (11.1%). Ten studies included wound length, which ranged from 1 cm to 47.55 cm.

Appearance, visual analog scale, Vancouver Scar Scale, Hollander scar scale, pruritus, pain, suture reaction, hypertrophic scar, dehiscence, wound spread, suture marks, patient preference and patient satisfaction were measured, with follow-ups ranging from 1 week to 37 months. Researchers said aesthetic outcome was influenced by suture technique in 15 articles (12 randomized control trials and three case series) covering 1,703 repairs (1,656, trunk and extremities; 47, face). The majority showed subcuticular closure to be superior to simple interrupted or simple running sutures, while nine studies with 370 repairs showed no difference in aesthetic outcome.

“The majority of the articles that we looked at did show a difference between suture techniques, and most of the literature … is based on the trunk and extremities,” researcher Thuzar M. Shin, MD, PhD, academic chief resident of the department of dermatology, University Hospitals Case Medical Center, Case Western Reserve University in Cleveland, told Healio.com. “Evidence-based medicine shows us that when you’re closing a linear wound on the trunk or the extremities, most often the best aesthetic outcome occurs when you use a subcuticular closure versus other closures that were studied.”

For more information:

Shin TM. “How Suture Technique Influences the Cosmetic Outcomes of Scars.” Presented at: American Society for Dermatologic Surgery 2012 Annual Meeting; Oct.11-15, Atlanta.