Study |

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.
Text Size: A A A
Published online

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

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Graphic Jump Location

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.

Place holder to copy figure label and caption
Graphic Jump Location

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.

Place holder to copy figure label and caption
Graphic Jump Location

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).

Place holder to copy figure label and caption
Graphic Jump Location

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.




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles