Comparison of Running Cutaneous Suture Spacing During Linear Wound Closures

Comment: This paper compares spacing of sutures and found no difference between those placed 2 mm and 5 mm apart. The closures examined were from surgical fusiform wounds. Of course, this is not analogous to the traumatic wounds encountered on call, but is food for thought, especially considering the time involved in placement of very fine sutures with no obvious cosmetic benefit (at least at three months).—Jennifer A. Villwock, MD

What are the outcomes and wound cosmesis achieved with running cutaneous sutures spaced 2 mm vs. 5 mm apart?

Bottom Line: No statistically significant difference in wound cosmesis or total complications were noted between running cuticular sutures spaced 2 mm vs. 5 mm apart. Both suturing techniques resulted in similar cosmetic outcomes and complication rates. Surgeons may want to consider whether the extra time involved in placing very closely spaced cuticular sutures is worthwhile.

Background: Surgeons have varying opinions on the ideal cutaneous suture spacing for optimal cosmetic outcomes. To date, no studies concerning the effect of suture spacing on cosmetic outcomes exist in the literature.

Study design: Randomized clinical trial.

Setting: University of California, Davis dermatology clinic.

Synopsis: The trial was conducted from November 28, 2017, to June 15, 2018. Fifty-six patients 18 years or older with surgical fusiform wounds (from Mohs procedure or surgical excision) on the head or neck with assumed closure lengths of at least 3 cm were screened. Resarchers excluded six patients, enrolled 50 patients, and followed up with 48 patients. Fifty surgical fusiform wounds were randomized to running cuticular closure with 2-mm spacing on half and 5-mm spacing on half. At three months, patients and two masked observers evaluated each scar using the patient and observer scar assessment scale (POSAS). A total of 50 patients (mean [SD] age, 71.1 [11.4] years; 43 [86%] male; 50 [100%] white) were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 10.7 (4.3) for the 2-mm interval side and 10.8 (3.5) for the 5-mm side at three months. No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the 2-mm interval side (10.2 [4.7]) and the 5-mm interval side (11.5 [6.4]) at three months. No statistically significant difference was observed in mean (SD) scar width between the 2-mm side (0.9 [0.6] mm) and the 5-mm side (0.8 [0.4] mm).

Citation: Sklar LR, Pourang A, Armstrong AW, et al. Comparison of running cutaneous suture spacing during linear wound closures and the effect on wound cosmesis of the face and neck: a randomized clinical trial [published January 16, 2019 online ahead of print]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.5057.