Dermatological surgery wound outcomes: assessing the evidence

Abstract

We would like to highlight some concerns regarding study design in dermatological surgery, which has resulted in low‐quality evidence to support the use of specific suture materials or suturing techniques with regards to wound outcomes.

Our first concern is the number of published studies adopting split‐scar study designs. This may appear to overcome the challenge of dealing with numerous confounding factors in surgical studies, but could also be inherently flawed as it assumes the management of one half of the wound is completely independent in outcome from that of the other half. For example, if one half of the wound becomes infected or undergoes wound dehiscence, it is likely this will also impact the other half of the wound and its outcome. This blurs the distinction of true outcome effect for each suture or wound‐closure method. Unfortunately, many of these studies are also limited to a single centre or even a single operator, reducing the external validity to other centres with differing operating cultures. We suggest the need for multicentre studies, randomizing by operator, hence each operator will have roughly 50% of patients they recruit randomly allocated to one arm and 50% to the other arm, to account for confounding factors that differ between surgeons.