Poor Scarring Research Articles

Twelve Steps to Optimize Scar Outcomes in External Rhinoplasty.

A well-healed scar extends beyond a mere superficial concern, reflecting the precision and care underlying the surgery. This study addresses the lack of recent literature on the complete closure technique for external rhinoplasty scars, emphasizing its potential impact on patient satisfaction and overall aesthetic quality. The main purpose of this article was to introduce and assess the efficacy of a novel closing suture technique for external rhinoplasty and emphasize on 12 specific steps for wound closure. A cohort of 104 patients who underwent external rhinoplasty utilizing the proposed closing suture technique were evaluated. Standardized photographic documentation and scar assessment were performed using the Vancouver-Manchester scale, considering notching, skin level differences, pigmentation, and overall appearance. The surgical approach involved a combination of vertical mattress and interrupted simple sutures, creating an effective closure framework. Analysis revealed an absence of poor scars, with 83.6% classified as good. Note that 65.5% of the good scars achieved a perfect 6-point score. While one moderate scar scored 3 points, the majority demonstrated optimal outcomes. Clinical photographs further illustrated the technique's success, showcasing imperceptible scars and reinforcing the efficacy of the complete closure approach. Our study introduces and assesses the efficacy of the complete closure technique for external rhinoplasty scars. The approach consistently yields positive outcomes, with an emphasis on almost imperceptible scars. While not achieving a 100% imperceptible scar rate, this study underscores the need for ongoing research to refine techniques and enhance patient satisfaction in external rhinoplasty. The proposed technique contributes significantly to scar management practices and encourages further exploration within the evolving landscape of rhinoplasty.

Tips and Tricks to Avoid Poor Scarring in Lip Lifting: A Technical Note.

Tips and Tricks to Avoid Poor Scarring in Lip Lifting: A Technical Note.

The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial

BackgroundPatients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. Setting and durationDepartment of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). MethodsThis randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. ResultsBoth groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). ConclusionThe purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.

Efficacy and optimal dose of acetic acid to treat colonised burns wounds: protocol for a pilot randomised controlled trial

IntroductionDespite of recent advancement in the burns wound management, burn wound infection (BWI) is still one of the major cause of burns mortality. Patients who survive their burns injury still...

Mitochondrial dysfunction in macrophages promotes inflammation and suppresses repair after myocardial infarction.

Innate immune cells play important roles in tissue injury and repair following acute myocardial infarction (MI). Although reprogramming of macrophage metabolism has been observed during inflammation and resolution phases, the mechanistic link to macrophage phenotype is not fully understood. In this study, we found that myeloid-specific deletion (mKO) of mitochondrial complex I protein, encoded by Ndufs4, reproduced the proinflammatory metabolic profile in macrophages and exaggerated the response to LPS. Moreover, mKO mice showed increased mortality, poor scar formation, and worsened cardiac function 30 days after MI. We observed a greater inflammatory response in mKO mice on day 1 followed by increased cell death of infiltrating macrophages and blunted transition to the reparative phase during post-MI days 3-7. Efferocytosis was impaired in mKO macrophages, leading to lower expression of antiinflammatory cytokines and tissue repair factors, which suppressed the proliferation and activation of myofibroblasts in the infarcted area. Mitochondria-targeted ROS scavenging rescued these impairments, improved myofibroblast function in vivo, and reduced post-MI mortality in mKO mice. Together these results reveal a critical role of mitochondria in inflammation resolution and tissue repair via modulation of efferocytosis and crosstalk with fibroblasts. These findings have potential significance for post-MI recovery as well as for other inflammatory conditions.

Retrospective Analysis of Predictive Factors for Complications in Abdominoplasty in Massive Weight Loss Patients.

Ex-obese patients present with redundancy of abdominal skin and soft tissue due to massive weight loss (MWL). The plastic surgeon can restore the body shape through body contouring procedures. Hence the need to adequately direct patients to body contouring by identifying suitable candidates exists. Our work aims to retrospectively analyze the abdominoplasty complications in our case series to identify associated risk factors and evaluate the effect of combined procedures on abdominoplasty outcomes. We retrospectively investigated predictive factors of abdominoplasty procedure complications on 213 MWL patients who received abdominoplasty with and without rectus sheath plication, abdominal liposuction, and other body contouring procedures. We identified risk and protective factors with univariate and multivariate regression analysis. Furthermore, we assessed the impact of additional procedures on the complication rates. The overall complication rate was 49.8% (26.8% minor complications; 23% major complications). The delayed wound healing rate was 27.7%, and the revision surgery rate was 25.8% (14.7% early revision; 14.2% late revision). These results were compared with literature reports. Several negative predictors emerged as non-modifiable (advanced age, diabetes mellitus, surgical mode of weight loss) or modifiable (preoperative obesity and body mass index (BMI); active smoking; preoperative anemia; use of fibrin glue or quilting sutures). Performing rectus sheath plication improved most of the outcomes. Liposuction of hypochondriac regions and flanks led to increased safety and reduced the risk of surgical dehiscence and delayed wound healing, in contrast to epimesogastric liposuction. The other combined body contouring procedures did not worsen the outcomes, except for poor scarring. Our findings encourage us to continue associating rectus sheath plication, liposuction, and other body contouring surgeries with abdominoplasty. We emphasize the importance of proper patient selection, particularly with regard to anemia, before body contouring surgery in the interests of offering safe surgery and satisfactory results. Further studies are needed to investigate how the optimal BMI cut-off and abstinence from smoking (in terms of time) before surgery reduce postoperative complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring.

Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.

Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. Therapeutic, IV.

"Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study.

BackgroundThe process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring.ObjectivesProphylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described.MethodsA high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale.ResultsThere have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545.ConclusionsProphylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance.Level of Evidence: 4

Ovarian transposition.

Vaginal evisceration of the small bowel is a surgical emergency insofar as it entails the risk of acute vascular lesions in the latter. It may be caused by a vaginal prolapse. Delayed treatment of a prolapse may entail the risk of poor scarring of vaginal suture, and sacrocolpopexy is not necessarily called for. In an 80-year-old female patient with repeatedly recurrent stage 4 vaginal prolapse, vaginal evisceration and vaginal prolapse were treated by perineal approach and emergency colpocleisis.

Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study.

Background:To enhance patient safety and prevent medico-legal complaints, we need to understand current trends and impacts. We aimed to characterize Canadian plastic surgery medico-legal patterns in many dimensions.Method:This retrospective descriptive analysis of Canadian Medical Protective Association data between January 1, 2013 and December 31, 2017 included closed regulatory body complaints and civil-legal actions involving plastic surgeons. We excluded class action legal cases and hospital complaints. We collected data on patient allegations, procedure types, healthcare-related patient harms, and peer expert criticisms. The primary outcome of interest was physician medico-legal outcome.Results:We found 414 cases that met the inclusion criteria: 253 (61.1%) cases involved cosmetic procedures and 161 (38.9%) noncosmetic procedures. The annual incidence among plastic surgeon members of regulatory body complaints and civil-legal actions was 12.1% and 6.7%, for a combined incidence of 18.8%. The most common allegations were deficient clinical assessment, inadequate informed consent, delayed or misdiagnosis, and inadequate monitoring. Leading contributing factors were physician–patient communication breakdown, deficient clinical judgments, and inadequate documentation. The top procedural complications included cosmetic deformity, poor scarring, upper extremity stiffness or deficit, major structural injury, and mental health disorder. Less than half of cases (198/414, 47.8%) had unfavorable medico-legal outcomes for the surgeon. Patients were compensated in 86/198 (43.4%) of civil-legal cases.Conclusions:Plastic surgeons experience more medico-legal complaints for cosmetic versus noncosmetic procedures. To minimize medico-legal risks, plastic surgeons should focus on strong physician–patient communication, patient education/consent, thorough clinical assessment, minimizing potentially preventable complications, and maintaining relevant documentation.

Optimizing Safety for the Postradiation Face Lift

Background: The growing population of aging patients who have received head or neck radiation has brought attention to the unique considerations for surgical face lifts. Tissue fibrosis and impaired microcirculation can compromise wound healing and increase overall complication rates. Our review of the literature identified few reported cases of postradiation face lifts. Methods: Three patients who underwent postradiation face lift procedures were identified within two senior surgeons’ practices. Patient demographics, medical history, surgical technique, postoperative course, and photographs were obtained. Complications were analyzed, including infections, hematomas, seromas, wound dehiscence, delayed healing, necrosis, nerve injuries, poor scarring, and systemic events. Results: None of the patients experienced immediate or major complications. All patients reported satisfaction with the procedure. One patient required a revision of the earlobe. Conclusions: Our limited series suggests that with a comprehensive approach and a deliberate surgical technique, safe and desirable outcomes may be achieved in the appropriately selected patient. We outline perioperative considerations to assist surgeons in caring for these patients. Additional research is necessary to assess the impact of patient and therapeutic variables.

Superior pedicle reduction mammoplasty supported by central glandular pedicle

Abstract Objectives: To evaluate effect of supporting superior pedicle by central glandular pedicle in reduction mammoplasty in improving aesthetic outcome and reducing the incidence of nipple areola necrosis and postoperative NAC loss of sensation.Background: Superior pedicle reduction mammoplasty provides good aesthetic outcome, but has high possibility of nipple areola complex loss of sensation, therefor keeping the central glandular portion as support to superior pedicle ensures good blood and sensory supply to NAC Methods: This study included 37 patients presented by breasts hypertrophy from March 2019 to March 2021. All patients’ breasts were examined for suprasternal notch to nipple distance, areolar diameter, nipple to infra mammary fold distance. Postoperative assessment included: Nipple areola complex vascularity, nipple areola complex sensitivity and patients’ satisfaction about breast contour, projection, symmetry, scars and overall aesthetic outcome using a score out of 4. Patients underwent marking using wise pattern for skin incision. Intraoperative; excision of skin, fat and glandular tissue inferior to NAC, starting from skin and went directly to chest wall keeping central breast mound with the superior pedicle. Finally closure was in vertical or inverted T pattern according to skin excess to be removed. Results: In this study we operated upon 37 patients who were asking for breast reduction aged between 20 and 57 years with mean age 39.6 years. The overall complication percentage 14.8% excluding poor scarring. We had no cases of total Nipple areola complex loss, low incidence of nipple areola complex persistent reduced sensation after 1 year of follow up (2.7%) and no complete loss of sensation in any patient. Aesthetic outcome accepted by 97.3% of patients. Conclusion: Superior pedicle reduction mammoplasty supported by central glandular pedicle helps in ensuring reliable blood perfusion and sensory nerve supply to nipple areola complex which reduces possibility of post-operative nipple areola complex necrosis and loss of sensation, while patient gets pleasant and long standing aesthetic outcome. Key words: superior pedicle - reduction- mammoplasty- supported by – central – glandular - pedicle

Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Upper Cutaneous Lip: A Systematic Review.

Despite many options for upper lip reconstruction, each method's advantages and disadvantages are unclear. To summarize complications and functional and aesthetic outcomes of localized skin flaps for oncological reconstruction of the upper cutaneous lip (PROSPERO CRD42020157244). The search was conducted in Ovid MEDLINE, Ovid EMBASE, and CENTRAL on December 14, 2019. Two reviewers screened 2,958 results for eligibility. Bias assessment was conducted using ROBINS-I criteria. Our search identified 12 studies reporting outcomes of V-Y advancement, ergotrid, rotation, Karapandzic, alar crescent, and propeller facial artery perforator flaps. Flap complications (infection, hemorrhage/hematoma, wound dehiscence, and flap necrosis) ranged from 0% to 7.69%. Functional outcomes (salivary continence, microstomia, and paresthesia) were poorest for Karapandzic flaps. Aesthetic outcomes, when reported, stated satisfaction rates greater than 90%. V-Y advancement flaps reported the highest rates of poor scarring (0%-20%) and need for revision surgery (0%-46.7%). Our results provide dermatologic surgeons an overview of upper cutaneous lip flap outcomes reported in the literature. In general, we noted high patient satisfaction rates and low complication rates. Additional research into outcomes of other commonly used flaps is needed. Standardization of reported outcomes could allow further comparison across different flaps or across studies of the same flap.

Emergency colpocleisis in a vaginal prolapse complicated by bowel evisceration

Vaginal evisceration of the small bowel is a surgical emergency insofar as it entails the risk of acute vascular lesions in the latter. It may be caused by a vaginal prolapse. Delayed treatment of a prolapse may entail the risk of poor scarring of vaginal suture, and sacrocolpopexy is not necessarily called for. In an 80-year-old female patient with repeatedly recurrent stage 4 vaginal prolapse, vaginal evisceration and vaginal prolapse were treated by perineal approach and emergency colpocleisis.

Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty.

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis. The authors continue by describing idealized basal view aesthetics and provide a treatment algorithm for common deformities that include alar flaring and a wide nasal base. The authors attempt to provide a comprehensive approach to the treatment of the nasal base by discussing the implications of treating columellar deformities, tip positioning, or alar-columellar discrepancies on the overall aesthetics of the lower third of the nose. Furthermore, technical considerations are given for common surgical maneuvers addressing the alar base to help guide treatment and prevent complications such as poor scarring, notching, nostril asymmetry or stenosis (external valve obstruction), and alar deformities ("parenthesis" or "bowling pin"), to name a few.

Classic Ehlers-Danlos syndrome and cardiac transplantation - Is there a connection?

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders comprised of several types. Classic EDS is an autosomal dominant disorder with stretchable skin, delayed wound healing with poor scarring, joint hypermobility with subluxations or dislocations, easy bruisability, hernias, aneurysms and cardiac abnormalities. Advances in genomics technology using next-generation sequencing has led to the discovery of causative genes for connective tissue disorders, hereditary cardiomyopathies and cardiovascular diseases including several genes for connective tissue disorders. A 55 year-old male exhibited thin stretchable skin, atrophic scars, easy bruising, joint pain and dislocations requiring multiple knee surgeries and a Beighton hyperflexibility score of 6 out of 7. He was found to have a heterozygous missense COL5A1 gene variant involving exon 3 at nucleotide c:305T>A with an amino acid position change at p.lle102Asn consistent with classic EDS. He had a heart transplant at 43 years of age due to cardiac failure of unknown cause. This patient with classic EDS is brought to medical attention and should be of interest to cardiologists, heart transplant specialists and surgeons, particularly in individuals with unexplained cardiac failure and then diagnosed prior to surgical intervention to avoid poor wound healing, scarring and other tissue involvement (e.g., vascular anomalies, blood pressure instability, aneurysms) as components of EDS.

Retrospective analysis of the predictive factors associated with good surgical outcome in brachioplasty in massive weight loss patients

Background Upper arm lift is a widespread body contouring procedure, but no globally accepted guidelines exist in selecting patients and, due to comorbidity and heterogeneity of them, it is difficult to identify predictive factors of good surgical outcome. The authors review the team’s experience of 56 brachioplasty performed in massive weighs loss patients. Methods Data of 56 consecutive arm lifts were reviewed for preoperative, perioperative and postoperative variables and outcomes (complications, scarring, wound healing, revision surgery, need for blood transfusion, satisfaction, etc.). Surgical technique and postoperative care are described. A statistical analysis was performed to identify relationship between possible predictive factors and outcomes. Furthermore, an evaluation of different employed wound management devices was conducted. Results Follow-up ranged from 6 to 36 months (mean 20.1 months). Outcomes summary is reported (overall complication rate 50%, poor scarring rate 25%, delayed wound healing rate 26.8%, revision surgery rate 37.5%, need for blood transfusion rate 8.9%, satisfaction rate 71.4%) and statistical investigation evidenced the role of prior plastic surgery BMI and the associated change in BMI before and after weight loss, just prior brachioplasty, and the modality of weight loss. Conclusion The authors’ technique resulted in positive outcomes overall, considering the difficulty in dealing with the problems of MWL patients. Based on our results, we aim to suggest to perform brachioplasty in patient with the lower achievable BMI (preferably <30kg/m2) to reduce the negative effect of unmodifiable factors as diabetes, modality of weight loss, a wide ΔBMI, and other well-known negative predictive factors.

Novel Magnetic Resonance Late Gadolinium Enhancement With Fixed Short Inversion Time in Ischemic Myocardial Scars.

Late gadolinium enhancement (LGE) visualizes scar tissue after myocardial infarction. However, in clinically used LGE sequences, subendocardial infarcts can be missed due to low contrast between blood pool and subendocardium. The purpose of his study was to compare scar visibility in a novel 3-dimensional (3D) single breath-hold inversion recovery sequence with fixed, short inversion time (TI = 100 milliseconds) (short LGE) and standard 3D LGE imaging with individually adjusted TI (LGE). Short LGE and LGE (both sequences with the same settings: spatial resolution, 1.2 × 1.2 mm; slice thickness, 8 mm; field of view, 350 × 350 mm; single breath-hold) were acquired in 64 patients with previous MI (13 female; mean age, 57 ± 19 years) at 1.5 T. Inversion time was set to 100 milliseconds in short LGE and adjusted individually in LGE according to the Look-Locker sequence. Two independent readers evaluated 1088 segments (17-segment model), identified infarcted segments, and categorized scar visibility (5 = excellent, 1 = poor scar visibility) and scar transmurality (4 = transmural, 0 = no scar) using a 5-point Likert scale. Signal intensity ratios between short LGE and LGE for scar and blood pool, for scar and remote myocardium, and for remote myocardium and blood pool were calculated. Short LGE showed 197 infarcted segments out of 1088 (18.1%); LGE revealed 191 segments (17.6%). Short LGE with dark scar and bright blood pool demonstrated better overall scar visibility, especially in subendocardially infarcted segments compared with LGE (4.2 vs 3.0, 5 = excellent visibility; P = 0.01). Signal intensity ratios for short LGE relative to LGE were 1.42 for scar/blood pool, 0.8 for scar/remote myocardium, and 0.22 for remote myocardium/blood.Overall transmurality was not rated higher in short LGE compared with LGE (P = 0.8). More fibrous tissue and total fibrous percentage (P = 0.04) were measured in short LGE compared with LGE, whereas myocardial mass was not significantly different (P = 0.5). Acquisition time was similar between short LGE and LGE (26 ± 4 seconds vs 25 ± 9 seconds, P = 0.7). Short LGE is a fast, single breath-hold 3D LGE sequence with no need for myocardial nulling due to fixed inversion time with improved scar visibility, especially in subendocardial infarcts.

Comparative study of linear closure technique versur purse string closure technique of skin closure in stoma reversal.

Objectives: To compare the results of linear closure technique with purse string closure technique in terms of surgical site infection, wound healing (scar cosmesis) and wound length. Study Design: Comparative Study. Setting: Surgical Unit V, Faisalabad Medical University, Faisalabad. Period: January 2016 to January 2019. Material &amp; Methods: A total of 100 patients were operated in our unit during the study period &amp; were allocated into two groups randomly: Group A (Linear closure) Group B (Purse string closure) included 50 patients in each group. The primary outcome measures were, surgical site infection, wound healing (scar cosmesis) and wound length. Results: During follow up period Surgical site infection was noted in 17 patients out of 100 with 14 patients in Group A and 03 Patients in Group B (p value 0.002). Regarding wound healing 60% patients were having good scar and 20% patients were having satisfactory and 20% having poor scar in Group A. while in Group B 82% patients were having good scar and 18% patients were having satisfactory scar (p value 0.00). Mean wound length in Group A was 5.14 with SD 1.2978 while in Group B mean length was 3.8 with SD 1.3095. Conclusion: Our study concludes that purse string closure is superior to linear closure technique in terms of surgical site infection, wound healing (scar cosmesis) and wound length.