SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 131 

RISING DERM STARS® 
 

 
Effect of Suture Spacing on Wound Cosmesis 
 
Karin Eshagh, MD1 
 
1Department of Dermatology, UC Davis Medical Center, Sacramento, CA 
 

 
 
Background: Sutures are the standard of 
care in repairing cutaneous wounds. Most 
surgical  reconstructions following Mohs 
micrographic surgery and standard surgical 
excisions require two layers of sutures: a 
deep layer and a top layer.  Some surgeons 
feel the need to place many deep sutures in 
order to reduce tension on the sutures and 
hence decrease the chance of wound 
separation and dehiscence. However, there 
are other surgeons who feel that deep 
sutures are only required in areas of high 
tension and that a higher number of deep 
sutures increases the risk of a spitting suture 
which leads to patient anxiety and poor 
wound cosmesis.  Thus, it is important to 
understand if an increased number of 
subdermal sutures is actually beneficial in 
terms of wound cosmesis. To our knowledge, 
there are no studies published on the effect 
of subdermal suture spacing on wound 
cosmesis. 
 
Objective: To determine whether the 
spacing between subdermal interrupted 
sutures during repair of linear cutaneous 
surgery wounds affects scar cosmesis.  In 
other words, the goal was to determine which 
of the following yields a more cosmetically 
appealing scar: many closely approximated 
subdermal sutures or fewer, more widely 
spaced subdermal sutures. The study 
specifically compared the effects of one 

versus two centimeter spacing between 
sutures. 
 
Methods: 50 patients were enrolled in a 
randomized clinical trial using a split wound 
model,  where half of the wound was repaired 
with sutures spaced two centimeters apart 
and the other half was repaired with sutures 
spaced one centimeter apart. Both the 
physician and patient were blinded as to 
which side received which treatment. Three-
months post-surgery, the scar was evaluated 
via POSAS: the Patient and Observer Scar 
Assessment Scale, a validated scar 
instrument.  
 
Results: No statistically significant difference 
seen between 1 cm spacing versus 2 cm 
spacing of subdermal sutures in preliminary 
analysis.  
 
Limitations: Our sample size was only 50 
patients. Future studies could examine larger 
populations. 
 
Conclusion: Suture spacing has no effect on 
wound cosmesis. Thus, placing fewer and 
more widely spaced sutures is more time 
efficient.