Purse-string suture vs second intention healing: results of a randomized, blind clinical trial.
OBJECTIVE
Purse-string suture is a closure method that purportedly reduces the scar area compared with second intention healing. Randomized clinical trials comparing these 2 methods appear to be limited or absent.


OBJECTIVE
To determine if purse-string suture improves cosmetic outcome, healing time, and scar to defect area compared with second intention healing for circular defects on the trunk and extremities.


METHODS
Prospective, 2-arm, randomized, evaluator-blinded clinical trial in a single-center outpatient academic dermatology center. Patients were eligible if they were older than 18 years, able to give informed consent, and had circular or oval postoperative defects larger than 8 mm on the trunk or extremities.


METHODS
For the purse-string treatment arm, wounds were sewn in circumferential fashion using polydiaxanone suture. Patients in the other treatment arm were allowed to heal by second intent.


METHODS
The primary outcome measures were the mean total Patient and Observer Scar Assessment Scale (POSAS) scores ascertained from the patient and 2 blinded observers. Secondary outcomes included the ratio of scar to initial defect size, healing time, pain scores, and complication rates.


RESULTS
Fifty-two patients were screened, and a total of 44 patients with 50 surgical sites were enrolled. Forty-two patients with 48 surgical sites completed the study. The mean total observer POSAS score was 18.38 for the purse-string group vs 19.91 for the secondary intention group, a nonsignificant difference (P = .41). Similarly, there were no significant differences for any of the following secondary outcome measures: mean total patient POSAS score (P = .96), mean scar-to-defect area (P = .61), and mean pain level at week 1 (P = .19). Statistical trends toward significance were seen in the mean healing time in favor of purse-string suture (P = .10) and scar relief, which favored second intention healing (P = .07).


CONCLUSIONS
The purse-string suture results in similar cosmetic outcomes, scar sizes, and pain levels compared with second intention healing for circular or oval wounds on the trunk and extremities. A larger study might better define the potential differences in our secondary outcome measures of healing time and scar relief.


BACKGROUND
clinicaltrials.gov Identifier: NCT02062866.
Department of Dermatology, University of California Davis Medical Center, Sacramento.
Jayne
J
Joo
Department of Dermatology, University of California Davis Medical Center, Sacramento.
Trenton
T
Custis
Department of Dermatology, University of Colorado Denver School of Medicine, Aurora.
April W
AW
Armstrong
Department of Dermatology, University of California Davis Medical Center, Sacramento.
Thomas H
TH
King
Department of Dermatology, University of California Davis Medical Center, Sacramento3Department of Dermatology, The Permanente Medical Group, Vacaville, California.
Kenny
K
Omlin
Laser & Skin Surgery Center of Northern California, Sacramento.
Stefani T
ST
Kappel
Department of Dermatology, University of California Davis Medical Center, Sacramento.
Daniel B
DB
Eisen
D000368:Aged; D002921:Cicatrix / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D016037:Single-Blind Method; D013536:Suture Techniques; D013537:Sutures; D014945:Wound Healing / Q000502:physiology*