title: Set-back versus buried vertical mattress suturing: results of a randomized blinded trial.
abstract: BACKGROUND
  The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes.
  
  
  OBJECTIVE
  We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS).
  
  
  METHODS
  A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar.
  
  
  RESULTS
  In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively).
  
  
  CONCLUSIONS
  Single institution experience and relatively short follow-up are limitations.
  
  
  CONCLUSIONS
  The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California; Department of Dermatology, Department of Veterans Affairs, Northern California Healthcare System, Mather, California.
authors.forename: Audrey S
authors.initials: AS
authors.lastname: Wang
authors.affiliation: Schweiger Dermatology, New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kleinerman
authors.affiliation: Department of Dermatology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fitzmaurice
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Anabella
authors.initials: A
authors.lastname: Pascucci
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Smita
authors.initials: S
authors.lastname: Awasthi
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Mondhipa
authors.initials: M
authors.lastname: Ratnarathorn
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Raja
authors.initials: R
authors.lastname: Sivamani
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California; Department of Dermatology, Department of Veterans Affairs, Northern California Healthcare System, Mather, California.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: King
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California. Electronic address: dbeisen@ucdavis.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Eisen
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects*; D059026:Diagnostic Self Evaluation; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000009:adverse effects / Q000193:education; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing
keywords: buried vertical mattress suture; cutaneous surgery; scar evaluation; set-back suture; subcuticular closure technique; wound eversion