Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound...

Area of Science:

• Dermatology
• Plastic Surgery
• Wound Healing Research

Background:

• Undermining is a surgical technique hypothesized to improve wound healing and cosmetic outcomes.
• However, robust clinical evidence from randomized controlled trials (RCTs) in humans is limited.

Purpose of the Study:

• To evaluate the efficacy of undermining in improving scar cosmesis for low to moderate tension wounds.
• This randomized clinical trial aimed to compare scar quality between undermined and non-undermined wound closures.

Main Methods:

• A randomized clinical trial involving 50 patients undergoing primary linear closure of cutaneous defects (≥3 cm).
• Wounds were bisected, with one half randomized to receive 2 cm of undermining and the other to receive no undermining.
• Scar outcomes were assessed at 3 months using the Patient and Observer Scar Assessment Scale (POSAS) by patients and masked observers.

Main Results:

• No statistically significant difference was observed in POSAS observer component scores between undermined (12.0) and non-undermined (11.1) sides (P=0.60).
• Patient-reported POSAS scores also showed no significant difference between undermined (15.9) and non-undermined (13.33) sides.
• Total complications did not differ significantly between the two wound closure techniques.

Conclusions:

• For wounds with low to moderate tension, undermining does not lead to statistically significant improvements in scar cosmesis compared to closure without undermining.
• The findings suggest that undermining may not be essential for optimizing scar outcomes in this patient population.