Subjects who consent to the study will have the following information recorded on the
date of surgery: age, sex, indication for surgery, surgical site, scar length, size and
type of buried intradermal suture, experience of surgeon (attending, fellow or resident),
and New Immigration Scale (NIS) skin color. Basic patient medical data pertinent to wound
healing/scar formation will be extracted from the medical record including history of
hypertrophic scar/keloids, smoking, diabetes mellitus, and immunosuppression.
The subjects will undergo elliptical excision per standard of care. A single polyglactin
910 suture buried intradermal suture will be placed at the center of the wound. If
additional buried intradermal sutures are needed, they will be placed equidistant from
the center of the wound such that each side has an equivalent number of intradermal
sutures. 5-0 polyglactin 910 will be used for wounds on the head and neck and 3-0 or 4-0
polyglactin 910 will be used for wounds on the trunk and extremities.
Following placement of the intradermal sutures, the subject's wound will be demarcated
into halves, labeled either "A" or "B." "A" refers to the left or the superior side, and
"B" refers to the right or inferior side. Prior to the study commencement, "A=fast gut"
will be written on 17 index cards and "B=fast gut" will be written on 17 index cards. The
index cards will be sealed in individual envelopes, shuffled to randomize, and stored
securely with the study materials. At the time of surgery, the surgeon will randomly
select an envelope which indicates which side will receive which suture type (either 5-0
fast absorbing gut or 5-0 polypropylene). This size of epidermal sutures will be used
regardless of site of wound. The intervention will be applied sequentially with side A
always being closed first. A simple running suture will be used on each half. The surgeon
will aim to keep suture technique including spacing and distance from wound edge
identical.
Following the procedure, a standard dressing will be applied and wound care will be
discussed. Patients will be seen, as is routinely performed clinically, for suture
removal for the polypropylene side in 7 days if the closure was on the head and neck and
10 days if the closure was on the trunk or extremities. Any residual component of fast
gut suture that has not yet dissolved will be removed by the medical assistant or nurse
so that the physician observer is blinded to which sutures were placed on which side. The
following information will be collected at this suture removal visit:
Photo of the scar
Patients will perform the patient portion of the POSAS (Patient and Observer Scar
Assessment Scale), a validated scale of scar cosmesis.
A co-investigator not present at the time of the surgical procedure will perform the
physician portion of the POSAS
Scar width will be measured 1 cm from midline on each side of the wound.
Measurements will be recorded in 0.5 mm increments.
Pain incurred with suture removal will be measured via a 10 point Visual Analog
Scale immediately after sutures are removed, with 1 representing no pain and 10, the
worst pain imaginable.
Patients will be asked to return for an in person clinic visit 3 months after surgery for
subsequent scar assessment. All surgical patients, not just those involved in the
research study, have follow up appointments for suture removal at 7-14 days and at 3-6
months, as per physician discretion. This time interval is the standard of care. The
following information will be collected at 3 month follow up:
Photo of the scar
Patient and observer POSAS scores (again, a co-investigator not present at the time
of the surgical procedure will perform the physician portion of the POSAS).
Dermatoscopic images of each side of the scar and of an area of normal skin. The
dermatoscopic images will be used to calculate a skin hyperpigmentation index (SHI)
score, a validated objective measure of skin hyperpigmentation
(https://shi.skinimageanalysis.com).
Scar width will be measured 1 cm from midline on each side of the wound.
Measurements will be recorded in 0.5 mm increments.
Clinical evidence of surgical site infection, wound disruption, and/or any other
postsurgical complications.
Patients who fail to attend the in-person 3 month follow up visit will be contacted by
telephone to complete the patient portion of the POSAS and asked to upload photos of the
scar to their medical record via MyUPMC. Storage of images of the scars will occur for
all patients, not just those participating in the study.
Upon completion of study visits, POSAS, SHI and other clinical data will be analyzed.
