Set-back versus buried vertical mattress suturing: results of a randomized blinded trial

Abstract

Background: The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes.

Objective: We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS).

Methods: A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar.

Results: In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively).

Limitations: Single institution experience and relatively short follow-up are limitations.

Conclusion: The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.

Keywords: buried vertical mattress suture; cutaneous surgery; scar evaluation; set-back suture; subcuticular closure technique; wound eversion.