Purse-string suture vs second intention healing: Results of a randomized, blind clinical trial
- Author(s): Joo, J
- Custis, T
- Armstrong, AW
- King, TH
- Omlin, K
- Kappel, ST
- Eisen, DB
- et al.
Published Web Locationhttps://doi.org/10.1001/jamadermatol.2014.2313
© Copyright 2015 American Medical Association. All rights reserved. IMPORTANCE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTIONS: 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. MAINOUTCOMES ANDMEASURES: 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 AND RELEVANCE: 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.
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