Department of Dermatology, University of California, Los Angeles, UCLA Medical Center, Los Angeles, CA, USA.
Department of Dermatology, UC Davis, Davis, CA, USA.
Br J Dermatol. 2022 Sep;187(3):318-323. doi: 10.1111/bjd.21625. Epub 2022 Jun 13.
Surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial cuticular layer. Some surgeons feel the need to place many deep sutures in order to reduce tension on cuticular sutures, as they believe this may decrease incidence of track marks and dehiscence, and lead to better cosmetic outcomes. However, others feel that a higher number of subcuticular sutures increases the risk of a suture reaction, which leads to patient anxiety and poorer wound cosmesis. To our knowledge, there are no studies published on the effect of subcuticular suture spacing on wound cosmesis.
To determine whether suturing with 1-cm interval subcuticular sutures results in better cosmetic outcomes than suturing with 2-cm interval subcuticular sutures.
Fifty patients were enrolled in a randomized clinical trial using a split-wound model, where half of the wound was repaired with sutures spaced 2 cm apart and the other half was repaired with sutures spaced 1 cm apart (ClinicalTrials.gov identifier NCT03327922). Both the evaluators and patients were blinded as to which side received which treatment. The scar was evaluated 3 months post-surgery by two blinded observers and the patients themselves using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment instrument.
The total mean POSAS score for observers for the sides that received 1-cm interval subcuticular sutures and the sides that received 2-cm interval subcuticular sutures did not differ significantly at 3 months (P = 0·34). There was also no significant difference in the patient assessment scale score between the two sides at 3 months (P = 0·084).
We found that 1-cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2-cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval. What is already known about this topic? Surgeons have differing opinions on the ideal frequency of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions. The effect of subcuticular suture spacing on wound cosmesis has not been previously explored in the literature. What does this study add? There was no significant difference in cosmetic outcome between 1-cm suture spacing and 2-cm suture spacing when evaluated by blinded observers and patients. Dermatology surgeons can use 2-cm suture spacing for increased efficiency, without significantly different cosmetic outcomes, detected by blinded observers and patients.
Mohs 显微外科手术后和标准外科切除后的手术重建通常采用两层缝线闭合：深层皮下层和浅层表皮层。一些外科医生认为需要放置许多深层缝线，以减少对表皮缝线的张力，因为他们认为这可能会降低痕迹和裂开的发生率，并导致更好的美容效果。然而，其他人认为更多的皮下缝线会增加缝线反应的风险，从而导致患者焦虑和伤口美容效果较差。据我们所知，目前尚无关于皮下缝线间距对伤口美容效果影响的研究。
确定 1cm 间隔皮下缝线缝合是否比 2cm 间隔皮下缝线缝合产生更好的美容效果。
采用裂伤模型，将 50 名患者纳入一项随机临床试验，其中一半伤口用 2cm 间隔的缝线缝合，另一半伤口用 1cm 间隔的缝线缝合（ClinicalTrials.gov 标识符 NCT03327922）。评估者和患者均对接受哪种治疗的伤口进行了双盲。术后 3 个月，两名盲法观察者和患者本人使用经验证的疤痕评估工具——患者和观察者疤痕评估量表（POSAS）对疤痕进行评估。
接受 1cm 间隔皮下缝线和接受 2cm 间隔皮下缝线的伤口在 3 个月时，观察者的总平均 POSAS 评分无显著差异（P=0.34）。3 个月时，两侧患者评估量表评分也无显著差异（P=0.084）。
我们发现，与 2cm 缝线间隔相比，盲法观察者或患者本人评估的 1cm 缝线间隔并未显著改善整体美容效果。我们的结果支持使用任何一种缝线间隔。
关于这个主题，已经有哪些已知的信息？外科医生对优化美容效果和最小化缝线反应的理想皮下缝线频率存在不同意见。文献中尚未探讨皮下缝线间距对伤口美容效果的影响。本研究有哪些新发现？在盲法观察者和患者评估中，1cm 缝线间距与 2cm 缝线间距在美容效果方面无显著差异。皮肤科外科医生可以使用 2cm 缝线间隔以提高效率，而不会导致盲法观察者和患者检测到明显不同的美容效果。
