title: Prevention of scar spread on trunk excisions: a rater-blinded randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Outpatient dermatology clinic at Dallas Veterans Affairs Hospital, Dallas, Texas.
  
  
  METHODS
  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.
  
  
  METHODS
  After excision, the wounds were closed with polyglactin 910 and poly-4 hydroxybutyrate (P4HB) sutures in opposite halves of the same wound.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Dermatology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9069, USA. kevinfkia@gmail.com
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kia
authors.forename: Molly V
authors.initials: MV
authors.lastname: Burns
authors.forename: Travis
authors.initials: T
authors.lastname: Vandergriff
authors.forename: Sarah
authors.initials: S
authors.lastname: Weitzul
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D002921:Cicatrix / Q000473:pathology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011091:Polyesters / Q000737:chemistry; D011098:Polyglactin 910 / Q000737:chemistry; D011446:Prospective Studies; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D060726:Torso / Q000601:surgery; D014945:Wound Healing / Q000502:physiology*
chemical_list: D011091:Polyesters; C107955:poly(4-hydroxybutanoate); D011098:Polyglactin 910