Effect of Adhesive Strips and Dermal Sutures vs Dermal Sutures Only on Wound Closure

Abstract

IMPORTANCE Although applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing, it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone. OBJECTIVE To determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure. DESIGN, SETTING, AND PARTICIPANTS A prospective, randomized split-wound intervention was conducted between November 14, 2013, and May 16, 2014, in patients who underwent cutaneous surgical procedures at the University of California, Davis, outpatient dermatology clinic. Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm, resulting from either Mohs micrographic surgical procedures or surgical excision, were screened for participation. Nine patients were excluded and 48 were enrolled. INTERVENTIONS Half of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only. MAIN OUTCOMES AND MEASURES At 3 months’ follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale. RESULTS The total mean (SD) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing (12.3 [4.8]) and the side that received sutures only (12.9 [6.3]) did not differ significantly at 3 months (P = .32). There was no significant difference in the total patient assessment scale score between the combination closure (14.0 [7.6]) and sutures only (14.7 [7.6]) sides at 3 months (P = .39). There was also no significant difference between the 2 closure methods in terms of mean (SD) scar width (both methods: 1.1 [0.8] mm, P = .89) at follow-up. CONCLUSIONS AND RELEVANCE Combination closure with adhesive strips and buried interrupted subcuticular suturing was not significantly associated with improved overall scar assessment compared with buried interrupted subcuticular suturing alone when evaluated by blinded observers or the patients themselves. Our results do not support the use of adhesive strips as a means to improve cosmetic outcomes or reduce scar width. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01979497

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Comparison of Running Cutaneous Suture Spacing During Linear Wound Closures and the Effect on Wound Cosmesis of the Face and Neck

“…Split-scar models have been used in the past to assess cuticular suturing techniques. [2][3][4] Ethical approval was obtained through the University of California, Davis Institutional Review Board before study commencement, and all patients provided verbal and written informed consent to enrollment. The trial protocol can be found in the Supplement.…”

Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative effectiveness trial

“…Ethical approval was obtained through the University of California, Davis Institutional Review Board before study commencement, and all patients provided verbal and written consent to enrollment. To minimize the number of uncontrolled variables, a split scar model was used, in congruence with past studies that have looked at cuticular suturing techniques [11][12][13].…”

“…The total score ranges from 6 to 60 with a lower score representing more normal appearing skin on the scale. The POSAS has been validated when 2 independent observers are used [18] and has been used in numerous surgical studies [12,13,17,[19][20][21][22][23][24][25]. The scar outcome was evaluated in person by the patient and 2 blinded observers who were not present during the intervention.…”