The Scar-suppressing Efficiency of Three Sutures with Different Degradation Rates: A Prospective Split-Scar Study

Background: Our previous study demonstrated that prolonged tension reduction results in satisfactory scar suppression during modified intradermal suturing. The type of suture used in intradermal sutures is crucial for tension preservation, wherein suture degradation results in tension reduction. However, evidence revealing the optimal suture to confront local tension for a prolonged period of time is lacking. Objective: To compare the aesthetic outcomes associated with three sutures: polyglactin acid and polydioxanone, which are absorbable sutures with tension-maintaining times of 1 and 3 months, respectively, and the nonabsorbable suture polyester. Methods: We evenly divided a hypogastric incision into three segments before randomly stitching them with three different sutures. After 1, 3 and 6 months, the aesthetic outcomes of the scars brought by each suture were evaluated by scar assessment scales. Results: Polyglactin acid had the worst aesthetic outcome at 1, 3 and 6 months. Polydioxanone and polyester had similar aesthetic outcomes at 1 and 3 months. However, at 6 months, polyester showed unsatisfying scar inhibition compared to that of polydioxanone. To explore the underlying mechanism, we repeated the above process in mice and found enhanced inflammation in tissues stitched using polyester. The inflammation neutralized the anti-scarring efficiency of reduced tension. Conclusion: Our study revealed that prolonged reduction in local tension plays an important role in inhibiting scarring, and the ability of sutures to induce local inflammation cannot be ignored. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266