Aesthetic Comparison of Abdominal Donor Site Scar Between Absorbable Dermal Staple and Subcutaneous Suture after Autologous Breast Reconstruction: A Prospective Randomized Controlled, Double-Blinded Study

Abstract

Background Abdominal tissue transfer has become the most commonly used tool for breast reconstruction. However, a secondary operator is often responsible for donor closure, which leaves dissatisfaction to patients due to inconsistent donor scars. Now, an absorbable dermal stapler is popularized worldwide and currently used for wound closure in many surgical fields. In this study, we aim to evaluate the abdominal donor site scar in using an absorbable dermal staple compared to a conventional suture. Methods This is a prospective, randomized controlled and double-blinded study. Between January 2018 and April 2019, a total of 30 patients who underwent breast reconstruction using abdominal flap were included. Donor sites were divided into equal halves, and the each dermal layer was sutured with either dermal staples or traditional suturing, respectively. At 1, 3 and 6 months after operation, the scar was evaluated by two blinded plastic surgeons by using the modified Manchester scar scale (MSS). Results An averaged sum of modified MSS was lower for the side sutured with a dermal stapler at the first month (11.76 +/- 2.12 vs. 12.28 +/- 2.03,p = 0.097), third month (12.17 +/- 1.86 vs. 12.62 +/- 2.31,p = 0.301) and sixth month (11.28 +/- 2.63 vs. 12.14 +/- 2.76,p = 0.051). Also, the dermal stapler side scored significantly higher for patient satisfaction than did the suture side (4.03 +/- 0.98 vs 3.66 +/- 0.97,p < 0.05). Conclusion The objective outcome of the scar closed by an absorbable dermal stapler was not statistically superior to conventional suturing. (p > 0.05) In the subjective outcome, however, it showed a significantly higher patients' satisfaction (p < 0.05).