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Prevention of Scar Spread on Trunk Excisions:  A Rater-Blinded Randomized Controlled Trial

Kevin F. Kia, MD; Molly V. Burns, MD; Travis Vandergriff, MD; Sarah Weitzul, MD
JAMA Dermatol. 2013;149(6):687-691. doi:10.1001/jamadermatol.2013.3004.
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Importance Wounds that heal under tension lead to wider and more conspicuous scars and result in decreased long-term patient satisfaction. We hypothesized that prolonged intradermal suture lifetime can decrease scar spread in wounds under tension.

Objective To determine whether prolonged intradermal support would help decrease scar spread.

Design Prospective, randomized, controlled, rater-blinded, split-scar trial.

Setting Outpatient dermatology clinic at Dallas Veterans Affairs Hospital, Dallas, Texas.

Patients Patients presenting with skin cancer on the trunk were considered for the trial. We included 25 distinct surgical sites on a total of 22 patients.

Intervention After excision, the wounds were closed with polyglactin 910 and poly-4 hydroxybutyrate (P4HB) sutures in opposite halves of the same wound.

Main Outcome Measures Quantitative scar spread at 12 months and qualitative assessment using a visual analog scale and Hollander Wound Evaluation Scale.

Results We found a statistically significant difference in scar width between the 2 suture materials, with a mean difference of 2.3 (95% CI, 1.0-3.6) mm (P < .001) favoring P4HB. A clinically significant difference on the visual analog and Hollander Wound Evaluation scales was not identified. Suture reactions were more common with P4HB.

Conclusions and Relevance Prolonged intradermal suture support leads to significantly decreased scar spread. However, the use of a longer-acting absorbable suture increases the rate of suture reaction noted at 3 months. Further studies into less reactive, longer-acting biomaterials are needed. In clinical practice, excisions in high-tension areas that are classically known to spread over time can benefit from longer-acting intradermal sutures.

Trial Registration clinicaltrials.gov Identifier: NCT00938691

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Figures

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Figure 1. Patient flowchart using CONSORT criteria. A total of 22 participants were enrolled in the study and intervention assignments were randomized. Because 3 participants had multiple (2) wounds (sites of intervention), a total of 25 wounds were enrolled in the study. Allocation consisted of wound suturing with polyglactin 910 (intervention A) and wound suturing with poly-4 hydroxybutyrate (intervention B). All wounds received interventions A and B in a split-scar design, with each wound divided into halves and individual halves assigned a suture material in a random fashion. Two participants were lost to follow-up before the final follow-up period; one died of pneumonia, and the other was homeless. The total number of participants undergoing analysis was 20.

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Figure 2. Scar spread over time. Points represent individual patients with the width of scar spread on the poly-4 hydroxybutyrate (P4HB) half plotted on the x-axis and on the polyglactin 910 half plotted on the y-axis. The diagonal reference line represents equal widths of both sides. Points above this line represent patients whose scars were wider on the polyglactin side compared with the P4HB side. A, Scar spread at 3 months after surgery. B, Scar spread at 12 months after surgery.

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Figure 3. Two representative scars at 1 year after surgery demonstrating a typical difference in scar spread. Thinner scars are seen on the wound halves sutured with poly-4 hydroxybutyrate (side A) compared with polyglactin 910 (side B).

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Figure 4. Example of suture reaction, an erythematous macule visible within the scar line, at 3 months within the poly-4 hydroxybutyrate (side B) half of a wound.

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