外线不缝合对皮肤切口愈合的影响的前瞻性自身对照临床试验

OBJECTIVE: To compare the impact of whether to apply the external suture after internal suture on skin incision healing. METHODS: This study was a prospective self-controlled clinical trial. From November 2020 to September 2021, 49 patients who underwent skin resection surgery and met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 39 females and 10 males, aged 18 to 55 years. The surgical sites included the upper limbs (17 cases), lower limbs (2 cases), shoulders (3 cases), neck (8 cases), abdomen (8 cases), chest (10 cases), and back (1 case). The surgical incision of each patient was divided equally into the external suture segment (with internal suture and external suture) and the external sutureless segment (with internal suture only) using the random sequence method. On the day of suture removal and at the 1(st) month of follow-up after surgery, the incision dehiscence was observed. At the 12(th) month of follow-up after surgery, the scar hyperplasia was observed and the scar hyperplasia rate of the incision was calculated. At the 6(th) and 12(th) months of follow-up after surgery, the scar width of incision was measured. At the 1(st), 6(th), and 12(th) months of follow-up after surgery, the Vancouver scar scale (VSS) was used to assess scar condition of the incision in terms of color, thickness, vascularization, and pliability, and the total score was calculated. The number of patients corresponding to the VSS score in the 1(st) and 12(th) months of follow-up after surgery was 41 and 46, respectively, while the number of patients corresponding to other indicators was 49. RESULTS: On the day of suture removal and at the 1(st) month of follow-up after surgery, no dehiscence was observed in either the external suture segment or external sutureless segment of any patient's surgical incision. At the 12(th) month of follow-up after surgery, the scar hyperplasia rate in the external suture segment was 2.04% (1/49), which was not significantly different from 4.08% (2/49) in the external sutureless segment (P > 0.05). At the 6(th) and 12(th) months of follow-up after surgery, the scar widths in the external sutureless segment of incision were 1.48 (1.01, 1.91) and 1.41 (1.13, 1.93) mm, respectively, which were not significantly different from 1.38 (1.00, 1.94) and 1.45 (1.17, 1.84) mm in the external suture segment (with Z values of 191.00 and 152.00, respectively, P > 0.05). At the 1(st), 6(th), and 12(th) months of follow-up after surgery, there were no statistically significant differences either in scores of scar color, thickness, vascularization, pliability, or in the total VSS score of the incision scar between the external suture segment and the external sutureless segment (P > 0.05). CONCLUSIONS: After skin incision is finely sutured internally with tension reduction, the presence or absence of external suture has no significant effect on the healing of the incision and the appearance of postoperative scar.