Set-back suture demonstrated superiority to current standard of care

CHICAGO − The set-back suturing technique resulted in superior wound eversion and better cosmetic outcomes compared with the current standard of care, the buried vertical mattress suture, according to research presented at the American Society for Dermatologic Surgery annual meeting.

Audrey Wang, MD, associate physician, University of California Davis, dermatology department, and colleagues conducted a split-wound, prospective, evaluator- and patient-blinded study in which surgical elliptical wounds of 46 patients were divided in half. They were randomized to receive subcuticular closure with the set-back suture (SS) on one half and buried vertical mattress suture (BVMS) on the other side.

Immediately following surgery, a measurement of the maximum eversion of one half of the sutured wound was conducted. Epidermal wound closure on both sides of the wound was achieved with adhesive skin closure strips. A 7-point Likert scale was used by two blinded observers to rate the healed scar. The validated Patient and Observer Scar Assessment Scale (POSAS) was completed by patients and observers, with lower scores indicating similarity to normal skin. At 3-month follow-up, scar width was measured 1 cm from midpoint of the scar for both sides, with incidence of spitting sutures recorded.

Forty-two patients (mean age, 65 years; 34 men) returned at 3 month follow-up. Immediately post-operatively, the SS resulted in statistically significant wound eversion height (mean 4.2 ± 2.0 mm vs. 2.7 ± 1.8 mm, P=.000) and width (mean 7.5 ± 4.6 mm vs. 5.9 ± 5.3 mm, P=.006). There were fewer spitting sutures (3 vs. 11, P=.058) on the SS side, and SS scars were not as wide (mean 2.1 ± 2.2 mm vs. 2.4 ± 2.6 mm, P=.265) compared with the BVMS suture side.

The blinded observers rated the SS side slightly better than the BVMS side. Total POSAS scores were significantly lower for the SS side compared with the BVMS side for both patients and blinded observers (subject mean 13.0 ± 8.7 vs. 16.2 ± 12.0 [P=.039]; observer mean 24.5 ± 10.4 vs. 27.7 ± 13.6 [P=.028], respectively). Overall POSAS scores for patients and observers also favored the SS side.

“Overall, we see that total scar did favor the set-back suture side by a statistical significance,” Wang said.

“The set-back suturing technique based on our study did demonstrate superior wound eversion, better cosmetic outcomes and fewer spitting sutures at 3 months,” she concluded.

For more information:

Wang A. Set-back Versus Buried Vertical Mattress Suturing: Results of a Randomized Blinded Trial. Presented at: American Society for Dermatologic Surgery 2013 Annual Meeting; Oct 3-6, Chicago.

Disclosure: The researchers report no relevant financial disclosures