Ideal Wound Closure Methods for Minimizing Scarring after Surgery: A Study in a Tertiary Care Hospital

Background:The healing of open cutaneous wounds involves the generation of vascularized granulation tissue that closes the gap in the skin.Thereafter, an effective epidermal barrier is created over the granulation tissue.Wounds in which sutures have approximated the edges also undergo granulation, albeit less than in open wounds that must heal by secondary intention.In both cases, the adherence of the wound edges becomes stronger over time.This study aimed to analyze the ideal wound closure methods for minimizing scarring after surgery.Material & Methods: This prospective observational study was conducted at Ibn Sina Medical College Hospital in Kallyanpur, Dhaka, Bangladesh from January 1st to December 30th, 2022.The study included a sample of 50 patients.A subcutaneous super-tension-reduction suture was used to minimize wound-closing tension by applying maximum tension reduction on both the dermis and subcutaneous tissue, away from the incision.The sampling technique used in this study was based on the operative technique.This suturing technique resulted in elevated wound edges centrally, creating a bump after tying the buried knot.Informed written consent was obtained from all study participants, and ethical clearance was obtained from the hospital's ethical review committee.Results: The wounds healed primarily in 49 cases.The bump at the incision began to flatten out after 2 to 3 months and was almost completely flat by 12 months postoperatively.The use of a subcutaneous supertension-reduction suture can greatly decrease tension on the dermis and the subcutaneous tissue.Conclusion: To reduce tension on the dermis, much deeper structures should be accessed, such as the superficial and deep fascia, and suture them.Another way to prevent pathological scar formation in high-tension areas is to use zigzag suturing techniques such as Z-plasty.