Scalp Closures With Pulley Sutures Reduce Time and Cost Compared to Traditional Layered Technique-A Prospective, Randomized, Observer-Blinded Study.
BACKGROUND
Reconstruction of postsurgical scalp defects can be difficult and time-consuming using a conventional bilayered technique. A specialized closure using a pulley suture can assist in closing wounds under high tension and can decrease time and cost for the surgeon.


OBJECTIVE
To determine if closing scalp defects with a single-layered closure using pulley sutures would result in decreased time but equivalent scar cosmesis compared to bilayered closures.


METHODS
A total of 21 patients with postsurgical scalp defects were randomized to a bilayered or a pulley group, and time was measured for each closure. Scar appearance was assessed using the Patient and Observer Scar Assessment Scale at 2 weeks, 2 months, and 6 months postsurgery. Before and after photographs were also assessed by a blinded dermatologist using the visual analog scale.


RESULTS
Compared to a bilayered closure, the pulley technique resulted in significantly reduced closure time (p < .001). Even though patient overall scores at 2 weeks and observer total score at 6 months were superior in the pulley group, the visual analog scale scores were similar between the 2 groups.


CONCLUSIONS
Scalp reconstructions using a single layer of pulley sutures result in time and cost reduction and similar scar appearance compared to bilayered closures.
*Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; †Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Swati
S
Kannan
Dhwani
D
Mehta
David
D
Ozog
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D011446:Prospective Studies; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D013536:Suture Techniques / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000191:economics