Purse-String Suture vs. Second Intention Healing

The purse-string suture has come to be recognized as a closure method which reduces the scar area, when compared with second-intention healing. The fact is, though, that randomized clinical trials comparing the two methods are few and far between.

With this background, a team of dermatologists from California and Colorado undertook research to determine whether purse-string sutures improve cosmetic outcome, healing time, and scarring, when compared with second-intention healing for circular defects on the trunk and extremities.

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The study was a prospective, two-arm, randomized, evaluator-blinded clinical trial in an outpatient academic dermatology center. To be eligible, participants had to be at least 18 years old, able to give informed consent, and to have circular or oval postoperative defects larger than 8 millimeters on their trunk or extremities.

For patients in 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 intention. Primary outcome measures were the mean total Patient and Observer Scar Assessment Scale (POSAS) scores as determined by the patient and two blinded observers. Secondary outcomes included the ratio of scar to initial defect size, healing time, pain scores, and complication rates.

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The researchers enrolled a total of 44 patients with 50 surgical sites-of those, 42 patients with 48 surgical sites completed the study. The mean total observer POSAS score was 18.38 for the purse-string group and 19.91 for the second-intention group, a non-significant difference. Moreover, there were no significant differences for any of the following secondary outcome measures: mean total patient POSAS score, mean scar-to-defect area and mean pain level at week one. Some statistical significance was found in two areas: mean healing time, which favored purse-string suture, and scar relief, which favored second-intention healing.

In short, the researchers found little difference between the two closure methods. “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,” they write, adding that a larger study might better define potential differences in healing time and scar relief.

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The study appears in the March issue of JAMA Dermatology.