The Length-Control Suture: A New Method for Prevention of Hypertrophic Scars and Dog-Ears
Alyssa J. Reiffel, M.D.1, Robert S. Reiffel, M.D.2.
1New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY, USA, 2White Plains Hospital Medical Center, White Plains, NY, USA.
BACKGROUND: Surgical and traumatic wounds develop hypertrophic scarring when exposed to lengthwise stresses during the initial phases of healing. Just as paper tape applied to the external surface of a wound prevents scar hypertrophy, a suture technique applied from the undersurface would need to impart the same absolute limitation on stretching to accomplish the same goal. The length-control suture (LCS) technique, in which a suture is passed in a closed-loop beneath the wound and anchored to the underside of the dermis, thereby pulling the apices of the wound inwards (Figures 1-2), was devised to protect wounds from these lengthwise forces. In addition, by using the LCS technique, dog-ears can be pulled into the center of the wound, thereby minimizing their appearance. Furthermore, if the LCS is placed under slightly greater tension, a convex shape can be created to overly a convex anatomical feature, such as a cheekbone or a shoulder.
METHODS: A retrospective review was performed of 230 consecutive patients who underwent wound closure with the LCS technique by a single surgeon (RSR) between 2006 and 2009. Wounds were evaluated at 6 weeks and 6 months postoperatively for signs of scar hypertrophy or widening.
RESULTS: The LCS technique was used to close 230 incisions, including 186 primary procedures and 44 scar revisions. Of these, 41 were on the thorax, 38 were on the extremities, and 151 were on the head and neck. In 223 cases (97%), the technique resulted in a scar that was thin, soft, and flat within 6 months. There were 6 cases of spitting and one case in which revision of a thigh wound did not result in a thin and flat scar.
CONCLUSIONS: The LCS technique is useful for a wide variety of surgical and traumatic wounds on the face, trunk and extremities. When employed, it results in scars that are flat, thin, and supple within 6 months. By using the LCS technique, wounds are protected from lengthwise stress, and therefore protected from the forces that lead to hypertrophic scarring. Furthermore, the LCS technique allows for a single-stage procedure with minimal dog-ear formation and a scar of limited length, even over convex surfaces.
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