Purse-string suture vs second intention healing: Results of a randomized, blind clinical trial

Jayne S Joo, Trenton Custis, April W. Armstrong, Thomas H. King, Kenny Omlin, Stefani T. Kappel, Daniel B Eisen

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)265-270
Number of pages6
JournalJAMA Dermatology
Volume151
Issue number3
DOIs
StatePublished - Mar 1 2015

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Sutures
Cicatrix
Randomized Controlled Trials
Arm
Extremities
Outcome Assessment (Health Care)
Pain
Cosmetics
Wounds and Injuries
Dermatology
Informed Consent
Outpatients
Clinical Trials
Therapeutics

ASJC Scopus subject areas

  • Dermatology

Cite this

Purse-string suture vs second intention healing : Results of a randomized, blind clinical trial. / Joo, Jayne S; Custis, Trenton; Armstrong, April W.; King, Thomas H.; Omlin, Kenny; Kappel, Stefani T.; Eisen, Daniel B.

In: JAMA Dermatology, Vol. 151, No. 3, 01.03.2015, p. 265-270.

Research output: Contribution to journalArticle

Joo, Jayne S ; Custis, Trenton ; Armstrong, April W. ; King, Thomas H. ; Omlin, Kenny ; Kappel, Stefani T. ; Eisen, Daniel B. / Purse-string suture vs second intention healing : Results of a randomized, blind clinical trial. In: JAMA Dermatology. 2015 ; Vol. 151, No. 3. pp. 265-270.
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AU - Omlin, Kenny

AU - Kappel, Stefani T.

AU - Eisen, Daniel B

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N2 - 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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