Does wound eversion improve cosmetic outcome?: Results of a randomized, split-scar, comparative trial

Abstract

Background: Wound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse.

Objective: We sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures.

Methods: We undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS).

Results: The total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up.

Limitations: This was a single-center trial, which used a validated but still subjective scar assessment instrument.

Conclusion: Wound eversion was not significantly associated with improved overall scar assessments by blinded observers or patient assessment.

Keywords: Patient Observer Self-Assessment Scale; cosmesis; eversion; inverted vertical mattress suture; set-back suture; surgical scars.

Conflict of interest statement

Conflicts of interest: None declared.

Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1

Wound immediately postoperative (left) and at 3-month follow-up (right). POSAS, Patient Observer Self-Assessment Scale.

Fig 2

Screening, enrollment, and follow-up of study patients.