Aesthetic Comparison between Subcuticular Suture and Staple Closure of Anterior Cervical Decompression and Fusion Incision Scars: A Prospective Controlled Single-blinded Trial.

Sina Rajamand,Diana Kakos,Doris Tong,Lucas Garmo,Teck M Soo

doi:10.7759/cureus.3996

Abstract

Introduction: Anterior cervical decompression and fusion (ACDF) procedures are common and neck scar appearance is important aesthetically. This study compared subcuticular suture closure with staple closure regarding the aesthetics of the neck incision scar.Methods: A single-blinded comparative prospective study with two cohorts involving one facility and multiple surgeons was done to study all consecutive patients who underwent one/two-level ACDF operations from 2015-2016. We excluded patients with corpectomies, postoperative wound infection, reoperations in the same admission, any previous ACDF operations, non-compliance in follow-up, and inability to give informed consent. We did single-layer skin stapling without platysma closure or subcuticular suture with platysma closure. Patients followed up between 1.5 and six months. We used the Stony Brook Scar Evaluation Scale (SBSES), range 0-5 with five being the best score. Digital images were taken in a standardized manner and saved in a secure database. A blinded plastic surgeon and a blinded neurosurgeon, not involved in the operation, evaluated the scars using SBSES. A priori sample size using a clinically significant difference of one was determined. Wilcoxon rank-sum test was used; a p-value <0.05 was considered statistically significant.Results: We studied 93 staple and 66 suture closures. There is no significant difference between the groups regarding age, sex, the incidence of diabetes, smoking, obesity (body mass index (BMI) >30 kg/m2), chemotherapy or the length of the incision. There is no statistically significant difference regarding SBSES as evaluated by the plastic surgeon (staples vs. sutures, median 2 vs. 2, range 0-5, p = 0.32). There is a statistically significant difference as evaluated by the neurosurgeon (staples vs. sutures, median 4 vs. 3, range 0-5, p = 0.003). Post hoc power analysis was 0.90.Conclusion: Using the validated SBSES to assess the aesthetic outcome of ACDF scars, we demonstrated that staples and sutures provide equivalent aesthetic outcomes per plastic surgeon evaluation, and staple closure results in statistically significant better aesthetic outcomes per neurosurgeon evaluation.

Highlights

Anterior cervical decompression and fusion (ACDF) procedures are common and neck scar appearance is important aesthetically
Using the validated Stony Brook Scar Evaluation Scale (SBSES) to assess the aesthetic outcome of ACDF scars, we demonstrated that staples and sutures provide equivalent aesthetic outcomes per plastic surgeon evaluation, and staple closure results in statistically significant better aesthetic outcomes per neurosurgeon evaluation
We seek to demonstrate that staple closure in anterior cervical incision gives an equivalent aesthetic outcome when compared to subcuticular suture closure

Summary

Introduction

Anterior cervical decompression and fusion (ACDF) procedures are common and neck scar appearance is important aesthetically. Anterior cervical spine procedures make up a significant portion of the clinical caseloads of neurosurgeons and orthopedic spine surgeons [1]. It is a relatively common procedure among the general population [2]. An anterior cervical incision can be closed in many ways, two of which are sutures versus staples, with sutures being the more common technique. Patient satisfaction with these two wound closure techniques is comparable [3]. We seek to demonstrate that staple closure in anterior cervical incision gives an equivalent aesthetic outcome when compared to subcuticular suture closure

Methods

Results

Conclusion