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Suture spacing yields similar cosmetic outcomes during linear wound closures

Researchers reported no statistically significant difference in wound cosmesis or total complications between running cutaneous sutures spaced 2 mm or 5 mm apart among patients who underwent Mohs procedures or surgical excision on the head or neck.

“There appears to be significant variation among surgeons regarding the spacing between sutures,” Lindsay R. Sklar, MD, of the department of dermatology at the University of California, Davis, School of Medicine, and colleagues wrote. “Some prefer closely spaced sutures, believing they result in better wound edge apposition and eversion and less potential edge misalignment. Others believe closely spaced sutures result in prolonged operative time, additional tissue trauma, and more foreign material within the wound, potentially worsening outcomes.”

To determine whether cutaneous suture spacing affects wound cosmesis during wound closure, Sklar and colleagues enrolled 50 patients (mean age, 71.1 years) with surgical fusiform wounds on the head or neck with assumed closure lengths of at least 3 cm into a randomized clinical trial.

Eighty-six percent of patients were men, and all patients were white.

The patients were randomly assigned to running cuticular closure with 2 mm spacing on half of the wound and 5 mm spacing on the other half.

Scars were evaluated at 3 months using the Patient and Observer Scar Assessment Scale (POSAS). The 3-month time frame was used “as differences in interventions tend to diminish with time,” the researchers wrote.

Two masked observers who were not present during the procedure were asked to evaluate multiple features of each half of the scar: vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion.

No significant difference was found in the primary outcome measure, the mean sum of the POSAS scores, with a mean score of 2.1 for the 2-mm side and 2.2 for the 5-mm side.

Additionally, they found no significant differences in individual components for vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion.

Researchers also noted no statistically significant difference for mean scar width at 3 months between the sides of the scars with spacing of 2 mm vs. 5 mm.

“Both techniques result in similar cosmetic outcomes and complication rates. Therefore,

surgeons may want to consider whether the extra time involved in placing very closely spaced cuticular sutures is worthwhile,” Sklar and colleagues wrote.

They concluded that the potential benefits of using wider-spaced cutaneous sutures for wound closure include decreased procedure time, suture material used and trauma to the skin, but were not a part of the study design and require further study in the future. – by Abigail Sutton

Disclosures: Sklar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.