Prevention of scar spread on trunk excisions: a rater-blinded randomized controlled trial.

Kia KF, Burns MV, Vandergriff T, Weitzul S.

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.

JAMA Dermatol. 2013 Jun 1;149(6):687-91. doi: 10.1001/jamadermatol.2013.3004.