Outcomes of cosmetic suturing for facial trauma in medically underserved counties of western China: A retrospective observational cohort study

Facial trauma is frequent in medically underserved regions of western China, where lack of access to specialized surgical care contributes to infection, hypertrophic scarring, and psychosocial distress. Although cosmetic suturing is widely used in plastic surgery, its systematic application in rural hospitals has not been well characterized. We conducted a single-center, retrospective, non-comparative observational cohort study at the Qingyang Hospital of Traditional Chinese Medicine from January to December 2024. Sixty consecutive patients (mean age 30.7 ± 13.6 years; 38 males, 22 females) with acute facial lacerations closed by direct approximation were included. Outcomes were evaluated at 6 months using the Vancouver Scar Scale (VSS) and patient satisfaction via the Visual Analog Scale. Logistic regression was performed to identify independent predictors of satisfaction. Falls (46.7%) and road traffic accidents (31.7%) were the leading causes of trauma. Mean scar length was 7.35 ± 5.02 cm, with 23.3% of patients presenting with multi-site lacerations. Superficial infection occurred in 2 cases (3.3%) and partial dehiscence in 3 cases (5.0%). At 6 months, 91.7% of patients reported satisfaction with cosmetic outcomes. The satisfied group demonstrated higher mean Visual Analog Scale scores (8.65 ± 1.03 vs 7.20 ± 0.45, P = .004) and lower mean VSS scores (1.74 ± 0.61 vs 2.90 ± 0.22, P < .001). Multivariate regression identified 2 independent predictors of satisfaction: lower VSS scores (odds ratio = 0.12, 95% confidence interval: 0.02-0.68, P = .016) and adherence to silicone therapy (odds ratio = 5.42, 95% confidence interval: 1.10-26.81, P = .038). In this non-comparative cohort, cosmetic suturing with layered closure and tension-reducing techniques, supplemented by scar management strategies, produced favorable short-term aesthetic outcomes in a rural Chinese hospital. However, interpretation is limited by the small sample size, 6-month follow-up period, and potential selection bias. Broader multicenter studies with longer follow-up are warranted to validate these findings.