Three suturing techniques for closing fusiform excisions. A randomised controlled study

Background/objectives: Australian doctors perform over one million skin excisions yearly. There are few randomised trials studying wound repair. The objective was to compare two suture techniques with controls for simple elliptical excisions in a prospective, randomised, single-blinded study.

Materials: One half of each wound was randomised to either one-layer closure with percutaneous nylon or modified two-layer closure where superficial closure was effected with adhesive tape. The control was the standard two-layer closure. Primary outcome measure was wound width at 6 months, with cosmesis as the secondary outcome.

Results: A total of 161 participants with 214 excisions were recruited from general practice. There was no significant difference in the primary outcome of wound width at 6 months between the groups. One-layer closure showed slight inferiority for cosmesis at 6 months versus the control. There was significant superiority for the modified two-layer closure versus the control for cosmesis at 6 months, and early wound erythema. Multivariate regression models adjusted for suture technique showed that younger age, wound infection and truncal location were predictors of increased scar width. Older age, wound erythema, and male gender were predictors of poorer patient-rated outcome.

Conclusion: One-layer closure is an acceptable choice for elliptical excision wound closure. Modified two-layer closure may be preferable to standard two-layer closure for elliptical wounds.