Comparison of wound strength, histologic, and aesthetic outcomes after microsurgical versus conventional skin closure in a rat model

Abstract

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague–Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5–10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p < 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden.

Keywords:

• Scar
• scar strength
• scar aesthetics
• microscope
• rat model

Acknowledgments

The authors would like to acknowledge the tremendous support of SSgt Elaine Spotts, SSG Kelly Caneen, SrA Tyler Lock, Ms Amy Taylor, Mr Miguel Rodriguez, Mr Carl Gibbins, and the entire staff of the 60th Medical Group Clinical Investigation Facility, Travis AFB, CA.

Disclosure statement

The views expressed in this material are those of the authors and do not reflect the official policy or position of the U.S. Government, the Department of Defense, or the Department of the Air Force. The animals involved in this study were procured, maintained, and used in accordance with the Laboratory Animal Welfare Act of 1966, as amended, and the Guide for the Care and Use of Laboratory Animals, National Research Council. The work reported herein was performed and funded under the United States Air Force Surgeon General-approved Clinical Investigation Number FDG20160025A. The authors have no other conflicts of interest to disclose.

Additional information

Funding

This work was supported by the United States Airforce.