Dermal suture only vs layered closure: a randomized split wound comparative effectiveness trial

Abstract Background Layered closure of cutaneous wounds is a commonly used surgical practice. However, there are studies to suggest the additional layer of epidermal sutures may not be necessary. Objectives To compare scar outcome of single layer of sutures placed in the dermis to the traditional layered closure when performing primary closure of cutaneous wounds. Methods A total of 49 patients were enrolled in a prospective, randomized, evaluator-blinded, split scar study to compare the results of conventional bilayered closure versus a single layer of buried dermal suturing of wounds closed primarily. The primary outcome measure was the mean sum Patient and Observer Scar Assessment Scale (POSAS) scores. Results At 3-month follow-up, there was a statistically significant difference for the mean total POSAS scores for both blinded observer and patient with preference for the traditional layered closure side. However, at 12-month follow-up, this difference was lost with the exception of scar color, which was significantly more noticeable on the side with only dermal sutures. Limitations Single-center study Conclusions At 3-months following surgery, the layered closure technique resulted in a slightly better scar than dermal sutures alone. At 12-months follow-up, this difference diminished with scars for both sides appearing similar.