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Prolonged suture support led to decreased scar spread

Prolonged intradermal suture support of excision sites among patients with truncal skin cancer led to significantly decreased scar spread, according to recent study data.

In a prospective, randomized, rater-masked, split-scar trial, researchers studied 25 surgical sites on 22 men (mean age, 68 years) presenting with skin cancer on the trunk at an outpatient dermatology clinic at Dallas Veterans Affair Hospital. All lesions were located on the back. Following excision, polyglactin 910 and poly-4 hydroxybutyrate (P4HB) sutures in opposite halves of the same wound were used for closure.

Quantitative scar spread at 12 months, along with qualitative assessment using visual analog scale and Hollander wound evaluation scale were used as main outcome measures.

Mean excision diameter was 2.3 cm and mean final length of closure was 7.2 cm. The two suture materials displayed a significant difference in scar width at 12 months, with mean scar spread of 0.9 mm for P4HB and 3.2 mm for polyglactin 910 (mean difference 2.3 mm; 95% CI, 1.0-3.6 mm). VAS and Hollander wound evaluation scale did not display clinically significant differences.

Eight complications were included in the side sutured with P4HB (35% of wounds), with seven minor asymptomatic local areas of erythema and one major significantly inflamed suture reaction to sterile abscess formation and drainage. The polyglactin 910 sutured side had two complications (9% of wounds), with one minor asymptomatic visible suture and one patient who was receiving aspirin and warfarin developing a hematoma. Secondary dehiscence was isolated to the polyglactin 910 sutured side of the wound.

“This study demonstrated significantly decreased scar spread favoring the longer-acting absorbable P4HB sutures,” the researchers concluded. “However, the use of longer-acting absorbable suture increased the rate of suture reaction noted at 3 months. This study serves as proof that prolonged intradermal support will reduce scar spread in high-tension areas. Further studies into less reactive, longer-acting biomaterials are needed.”