Comparison of Three Different Methods of Skin Closure in Anterior Midline Incisions of the Knee

Document Type : RESEARCH PAPER


1 Shahid Ghazi Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

2 Shohada Teaching Hospital, Tabriz University of Medical Sciences Tabriz, Iran.


 Few clinical trials have studied the functional and cosmetic outcomes of different closure tech- niques of surgical incisions. Skin wound and incision closure methods may influence the healing process and cos- metic outcome.
The present study aims at comparing three different suture techniques of skin closure. Methods: In a clinical trial, sixty patients with anterior cruciate ligament reconstruction surgery were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three methods: simple, vertical mattress, or semisubcuticular suture.
 After six months follow-up, we took a photograph of the healed wound in each individual. The cosmetic outcome was evaluated and rated by three orthopedic surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up regularly for dehiscence, infection or abnormal discharges.
 There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores obtained from three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 for the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 for the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 for the semisubcuticular method. The overall agreements between observers were weak to moderate.
Slight superiority of the cosmetic outcome of semisubcuticular sutures was not statistically significant.
The methods used for suturing an anterior midline incision of the knee does not seem to affect the final cosmetic outcome and the concept of different surgeons from a favorable cosmetic result may vary considerably.


  1. Singer AJ, Gulla J, Hein M, Marchini S, Chale S, Arora BP. Single-layer versus double-layer closure of facial lacerations: a randomized controlled trial. Plast Reconstr Surg. 2005;116(2):363-8.

  2. Khan RJ, Fick D, Yao F, Tang K, Hurworth M, Nivbrant B, et al. A Comparison of three methods of wound closure following arthroplasty. J Bone Joint Surg Br. 2006;88(2):238-42.

  3. Vanholder R, Misotten A, Roels H, Matton G. Cyanoacrylate tissue adhesive for closing skin wounds: a double blind randomized comparison with sutures. Biomaterials. 1993;14(10):737-42.

  4. Singer AJ, Quinn JV, Thode HC Jr, Hollander JE; TraumaSeal Study Group. Determinants of poor outcome after laceration and surgical incision repair. Plast Reconstr Surg. 2002;110(2):429-35.

  5. Biddlestone J, Samuel M, Creagh T, Ahmad T. The double loop mattress suture. Wound Repair Regen. 2014;22(3):415-23.

  6. Gurusamy KS, Toon CD, Allen VB, Davidson BR. Continuous versus interrupted skin sutures for non-obstetric surgery. Cochrane Database Syst Rev. 2014; 2: CD010365.

  7. Shamiyeh A, Schrenk P, Stelzer T, Wayand WU. Prospective randomized blind controlled trial comparing sutures, tape, and octylcyanoacrylate tissue adhesive for skin closure after phlebectomy.Dermatol Surg. 2001;27(10):877-80.

  8. Eaglstein WH, Sullivan TP, Giordano PA, Miskin BM. A liquid adhesive bandage for the treatment of minor cuts and abrasions. Dermatol Surg. 2002;28(3):263-7.

  9. Toriumi DM, O’Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg. 1998;102(6):2209-19.

  10. Quinn JV, Drzewiecki AE, Stiell IG, Elmslie TJ. Appearance scales to measure cosmetic outcomes of healed lacerations. Am J Emerg Med. 1995;13(2):229-31.

  11. Quinn J, Cummings S, Callaham M, Sellers K. Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ. 2002; 325(7359):299.

  12. van den Ende ED, Vriens PW, Allema JH, Breslau PJ. Adhesive bonds or percutaneous absorbable suture for closure of surgical wounds in children. Results of a prospective randomized trial. J Pediatr Surg. 2004; 39(8):1249-51.

  13. van den Ende ED, Vriens PW, Allema JH, Breslau PJ. A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery. Surgery. 2004;136(3):593-9.

  14. Gandham SG, Menon D. Prospective randomized trial comparing traditional suture technique with the dynamic sliding loop suture technique in the closure of skin lacerations. Emerg Med J. 2003;20(1):33-6.

  15. Adams B, Levy R, Rademaker AE, Goldberg LH, Alam M. Frequency of Use of Suturing and Repair Techniques Preferred by Dermatologic Surgeons. Dermatol Surg, 2006;32:682–689.

  16. Quinn J, Wells G, Sutcliffe T, Jarmuske M, Maw J, Stiell I,  et al. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med. 1998;32(6):645-9.

  17. Bernard L, Doyle J, Friedlander SF, Eichenfield LF, Gibbs NF, Cunningham BB. A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents. Arch Dermatol. 2001;137(9):1177-80.

  18. Webster DJ, Davis PW. Closure of abdominal wounds by adhesive strips: a clinical trial. Br Med J. 1975;3(5985):696-8.

  19. Ong CC, Jacobsen AS, Joseph VT. Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: a prospective, randomised trial. Pediatr Surg Int. 2002;18(5-6):553-5.

  20. Shetty AA, Kumar VS, Morgan-Hough C, Georgeu GA, James KD, Nicholl JE. Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial. J Orthop Surg (Hong Kong). 2004;12(2):191-3.