1. When comparing the cosmetic outcome of two different methods of wound closure (interrupted subcuticular sutures alone vs. the combination of overlying adhesive strips and buried interrupted subcuticular sutures), there was no appreciable difference in cosmetic outcome or scar width.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Traditional closure of cutaneous wounds involves closure with dermal and cuticular sutures. Furthermore, some studies have shown that providing additional support for wound closure via overlying adhesive strips in combination with dermal sutures may have a higher efficacy. These authors sought to investigate whether the addition of adhesive strips for wound closure would improve cosmesis or reduce scar width as compared to traditional closure. Results showed that there was no significant difference in cosmetic outcome between the two methods. While the randomized split-wound design strengthened the study, the findings were limited in applicability as data was obtained from a single-center.
In-Depth [randomized controlled trial]: Forty-eight patients were prospectively enrolled in the trial, after undergoing either a Mohs procedure or an excision. The mean age of participants was 63.5 years and most participants were Caucasian. The majority of procedures were on the face, torso, and upper extremities. In a split-wound intervention design, half of each wound was randomized to receive either only subcuticular buried vertical mattress sutures or a combination of buried vertical mattress sutures with overlying adhesive strips. At three months follow-up patients and two blinded observers assessed cosmetic outcome of both sides of the wound using the validated patient observer scar assessment scale (POSAS). There was no significant difference in mean POSAS score for observers between the two methods (12.3 for combination closure vs. 12.9 for sutures only, p = 0.32), nor was there a significant difference in total POSAS score for patients (14.0 for combination closure vs. 14.7 for sutures only, p= 0.39). There was also no statistically significant difference in scar width between the two methods (both methods: 1.1 mm, p=.89).
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