Quantification of Erythema Associated With Continuous Versus Interrupted Nylon Sutures in Facial Surgery Repair: A Randomized Prospective Study

Abstract

BACKGROUND Patients are often concerned about the cosmetic appearance of scars following Mohs micrographic surgery (MMS), including residual erythema. However, few studies have compared the cosmetic outcomes between different suturing techniques. OBJECTIVE To compare the erythema intensity (EI) associated with interrupted sutures (IS) and continuous sutures (CS), and the degree of its reduction over time. MATERIALS AND METHODS Mohs micrographic surgery patients were randomized to have half of their defect repaired with IS and the other half with CS. Postoperatively, subjects were assessed at 1 week, 2 months, and 6 months and close-up photographs of their scars were taken. Computer-assisted image analysis was utilized to quantify the EI in each half-scar. RESULTS The average EI of IS was greater than that of CS by 9.3% at 1 week (p < .001) and 7.2% at 2 months (p < .021) but comparable at 6 months. These differences were clinically detectable, but EI differences resolved by 6 months in most cases. At 6 months, EI regressed by 33.5% in IS and 26.3% in CS. CONCLUSION Continuous sutures are associated with less erythema during early scar maturation but are comparable to IS at 6 months. These results may guide the choice of suturing technique to improve early cosmetic outcomes and overall patient satisfaction.

Comparing running vs interrupted sutures for skin closure: A systematic review and meta‐analysis

“…Recent trials have been carried out using a colourimeter to compare the colour difference between the suture area and the patient's own colour. 22 , 40 It is considered a more objective method to evaluate the intensity of edema and the development of pigmentation. Future trials with more extended follow‐up periods are needed to assess the impact of the difference in skin suturing techniques from a more comprehensive perspective.…”

“…Other complication events, such as symptoms of edema, swelling, pain and itchy and development of keloid scarring, hypertrophy and pigmentation, remain to be discussed. Recent trials have been carried out using a colourimeter to compare the colour difference between the suture area and the patient's own colour 22,40 . It is considered a more objective method to evaluate the intensity of edema and the development of pigmentation.…”

Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study

“…Further information regarding Delta E computation and validation for color analysis and comparison can be found in the literature. [8][9][10][11][12]…”

“…All statistical analyses were performed with MATLAB software, similar to our group's previous study. 8 To determine an appropriate sample size, power calculations were performed before study enrollment. To allow for the detection of a clinically relevant difference of >1 interval in EI (moderate effect size of 0.5) with a power of 80% and a significance level of 5% (2 tailed), a total of 65 patients was required.…”

State of the Evidence for Facial Skin Cancer Reconstruction

“…RCTs have demonstrated that continuous nylon sutures are associated with less erythema during early scar maturation but are comparable to simple interrupted nylon sutures at 6 months. 58,59 A recent randomized, blinded, split-scar trial of 101 patients has shown no difference in cosmetic scar outcomes between the use of rapidly absorbable polyglactin or nylon suture. 60 This finding has been repeatedly demonstrated in clean wounds of both the face and neck.…”