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Purse-string suture vs second intention healing: results of a randomized, blind clinical trial
Jayne Joo1, Trenton Custis1, April W Armstrong2
1Department of Dermatology, University of California Davis Medical Center, Sacramento.
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.
Main Outcomes And Measures:
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.
Trial Registration:
clinicaltrials.gov Identifier: NCT02062866.
