Introduction: Skin defects can be repaired via primary closure, secondary intention healing, local and distant flaps, skin grafts or application of natural and synthetic skin substitutes. When possible, primary linear repair is favored due to simplicity, minimal morbidity and rapid healing. A number of suture techniques are available to the surgeon for primary closure, the selection of which depends on defect size, anatomic location, wound eversion, and tension.<BR />
Objective: To review suture techniques and how they influence scar cosmesis.<BR />
Methods: PubMed was searched using the following key words: <em>cosme*</em> in combination with <em>cutaneous suture, simple interrupted, simple running, running locked, vertical mattress, horizontal mattress, buried, subcuticular, running vertical mattress, running horizontal mattress, buried vertical mattress, butterfly suture,</em> or <em>pulley suture</em>. Information on study type, number of patients, age, gender, defect type, anatomic location, suture technique, scar length, follow up, and outcomes measured were tabulated.<BR />
Results: Twenty-four articles - 17 prospective randomized controlled trials including 1,473 subjects and 1,608 repairs and seven case series including 465 subjects and repairs - were reviewed. Fifteen articles - 12 randomized controlled trials and three case series - demonstrated that aesthetic outcome was influenced by suture technique, the majority of which showed subcuticular closure to be superior to simple interrupted or simple running sutures. No difference in aesthetic outcome was observed in nine studies, which included 370 repairs.<BR />
Discussion: Review of the literature supports the use of subcuticular closure over simple interrupted or simple running sutures on the trunk and extremities for improved aesthetic outcome.