Poor correlation of short- and long-term cosmetic appearance of repaired lacerations

Abstract

Objective: To describe the consistency of a cosmetic scale for repaired lacerations and to determine whether the appearance of lacerations at the time of suture removal correlates with the appearance six to nine months later.

Methods: A convenience sample of patients who had lacerations repaired in a university teaching hospital were evaluated at the time of suture removal and six to nine months following repair. All lacerations were assigned 0 or 1 point each for the presence or absence of a step-off borders, contour irregularities, margin separation, edge inversion, excessive distortion, and overall appearance. A total cosmetic score (0-6) was calculated by adding the scores for the categories above. The consistency of the cosmetic scale was assessed by comparison of scores given by two different practitioners evaluating each patient at suture removal and long-term follow-up. The 38 evaluating practitioners were assigned based on availability and did not necessarily perform serial evaluations of the same patient.

Results: The 41 participating patients had a median age of 19 years (range, 2-82 years). Wounds were located predominantly on the head (73%) and upper extremity (22%). Long-term follow-up was performed at a median of 219 days (range, 155-280 days) after suture removal. Interpractitioner concordance regarding optimal appearance (score of 6 vs < or = 5) was moderate (kappa = 0.52) at the time of suture removal and substantial at the time of long-term follow-up (kappa = 0.68). However, the correlation of actual scores at the time of suture removal vs at long-term follow-up was poor (r = 0.17, p = 0.29).

Conclusion: For our clinicians, the six-item categorical scale appears consistent as a tool for the assessment of the cosmetic appearance of wounds. However, correlation between laceration appearance at the time of suture removal and six to nine months later is poor.