title: Comparison of three skin closure methods in knee mid-anterior incisions.
abstract: BACKGROUND
  Few clinical trials have studied the functional and cosmetic outcomes using different closure techniques for surgical incisions. Since wound and rupture closure methods may influence the healing process and cosmetic outcome, the present study aims at comparing three different suture techniques.
  
  
  METHODS
  In a clinical trial, sixty patients with an anterior cruciate ligament rupture were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three techniques: simple, vertical mattress, or semisubcuticular suture techniques. After six months follow-up, we take a picture of the healed wound in each individual. The cosmetic outcome was rated and evaluated by three Orthopedic Surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up for inflammation, infection, or discharges.
  
  
  RESULTS
  There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores for three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 in the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 in the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 in the semisubcutaneous method. Overall agreements between observers were weak to moderate. Slight superiority of the semisubcuticular sutures were not statistically significant.
  
  
  CONCLUSIONS
  The methods used for suturing an anterior midline incision of the knee does not seem to affect the final cosmetic outcome. The concept of different surgeons from a favorable cosmetic result could totally differ.
authors.affiliation: Amir Mohammad Navali MD, Shahid Ghazi Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Amir Mohammad
authors.initials: AM
authors.lastname: Navali
authors.affiliation: Amir Mohammad Navali MD, Shahid Ghazi Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Tabrizi
keywords: Closure; Cosmetic; Knee surgery; Suture technique