Comparison of Three Different Methods of Skin Closure in Anterior Midline Incisions of the Knee

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Background:  Few clinical trials have studied the functional and cosmetic outcomes of different closure tech- niques of surgical incisions. Skin wound and incision closure methods may influence the healing process and cos- metic outcome. The present study aims at comparing three different suture techniques of skin closure. Methods: In a clinical trial, sixty patients with anterior cruciate ligament reconstruction surgery were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three methods: simple, vertical mattress, or semisubcuticular suture.  After six months follow-up, we took a photograph of the healed wound in each individual. The cosmetic outcome was evaluated and rated by three orthopedic surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up regularly for dehiscence, infection or abnormal discharges.  Results:  There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores obtained from three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 for the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 for the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 for the semisubcuticular method. The overall agreements between observers were weak to moderate. Slight superiority of the cosmetic outcome of semisubcuticular sutures was not statistically significant. Conclusions: The methods used for suturing an anterior midline incision of the knee does not seem to affect the final cosmetic outcome and the concept of different surgeons from a favorable cosmetic result may vary considerably.