Set-back versus buried vertical mattress suturing: Results of a randomized blinded trial

Audrey S. Wang, Rebecca Kleinerman, April W Armstrong, Sarah Fitzmaurice, Anabella Pascucci, Smita Awasthi, Mondhipa Ratnarathorn, Raja Sivamani, Thomas H. King, Daniel B. Eisen

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes. Objective We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS). Methods A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar. Results In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P =.039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P =.028], respectively). Limitations Single institution experience and relatively short follow-up are limitations. Conclusion The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.

Original languageEnglish (US)
Pages (from-to)674-680
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number4
StatePublished - Apr 1 2015


  • cutaneous surgery
  • Key words buried vertical mattress suture
  • scar evaluation
  • set-back suture
  • subcuticular closure technique
  • wound eversion

ASJC Scopus subject areas

  • Dermatology
  • Medicine(all)


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