title: Cosmetic results of lower midline abdominal incision: Donati stitches versus a continuous intracutaneous suture in a randomized clinical trial.
abstract: BACKGROUND
  The objective of this study was to compare the cosmetic outcome of two different closing techniques for lower midline abdominal incisions: a continuous intracutaneous suture versus interrupted Donati stitches.
  
  
  METHODS
  Eighty patients undergoing gynecological surgery through a lower midline abdominal incision were randomized. The cosmetic outcome of the scar was assessed by independent observers and the patients at 8 days and 4-6 months after the operation using visual analog scales and a validated scoring system for hypertrophy, width, color, and cross-hatching. Patients also completed a visual analog scale for postoperative pain on both occasions. The accumulated data were statistically evaluated using two-sided chi 2, Student's t, or Mann-Whitney tests with a confidence interval of 95%.
  
  
  RESULTS
  Closing a lower midline abdominal laparotomy wound with an absorbable intracutaneous suture did not take more time than using Donati stitches. Laparotomy scores were only significantly better in the intracutaneous group at the first assessment, one week after the operation. The cosmetic visual analog scale scores by both independent observers and patients were slightly better in the intracutaneous group but the difference was not statistically significant. There was also no significant difference between visual analog scale scores for pain felt around the scar.
  
  
  CONCLUSIONS
  This study shows that in the opinion of both independent observers and patients, scar cosmetics are not significantly different when using Donati skin sutures or an intracutaneous suture to close a lower midline laparotomy wound. The two methods do not differ either in time-consuming aspects or postoperative pain perception.
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center Haaglanden, the Hague, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: de Waard
authors.forename: Baptist
authors.initials: B
authors.lastname: Trimbos
authors.forename: Lex
authors.initials: L
authors.lastname: Peters
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D004146:Dioxanes; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008875:Middle Aged; D009757:Nylons; D017060:Patient Satisfaction; D011091:Polyesters; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
chemical_list: D004146:Dioxanes; D009757:Nylons; D011091:Polyesters; C095495:glycolide E-caprolactone copolymer