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Suture Techniques for Trunk and Extremity Closures
The appearance of postexcisional scarring on the trunk and extremities can be improved with the right suturing technique.
Excisions on the trunk and extremities often result in unattractive scars. Which suture technique gives the best result? In this rater-blinded, randomized trial, 36 patients with two atypical nevi on the trunk and extremities had them excised by one of three dermatologic surgeons. The resulting fusiform defects were closed with Vicryl deep sutures (3-0 on back, 4-0 on other areas). The skin-edge closure was randomly assigned to one of four techniques: (1) simple running 5-0 Prolene sutures removed at 14 days, (2) running subcuticular 5-0 Prolene sutures removed at 14 days, (3) running subcuticular 5-0 Prolene sutures left in place, or (4) running subcuticular 5-0 Vicryl sutures left in place. The scars were evaluated at 3 and 9 months.
The best overall scar appearance and the least redness occurred with the Vicryl closure. Contour irregularity was worst with the subcuticular Prolene suture left in place. Edge inversion was best with the subcuticular Prolene suture left in place and worst with the subcuticular Prolene suture removed at 14 days. Differences among the techniques declined between the 3-month and 9-month evaluations. At 9 months, there was no difference between techniques in scar width or excessive scar distortion. The back was the site of greatest scar spread, regardless of suture technique.
Comment: Running subcuticular Vicryl closure left in place produced the best scars. An added benefit of using the same suture for both deep and superficial suturing is a reduction in suture costs of about one half, which at $6 to $10 per suture can be quite significant. Unfortunately, no method had an advantage in minimizing scar spread. This result could be related to the use, in the deep closure, of Vicryl sutures that lose half their tensile strength in about 1 month. The use of a longer-lasting suture, such as polydioxanone (PDS) or even a nonabsorbable suture, for the deep suturing might have reduced scar spread.
— George J. Hruza, MD
Published in Journal Watch Dermatology October 20, 2006
Citation(s):
Alam M et al. Aesthetic and functional efficacy of subcuticular running epidermal closures of the trunk and extremity: A rater-blinded randomized control trial. Arch Dermatol 2006 Oct; 142:1272-8.
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