Introduction: ACS procedures are common and neck scar appearance is important aesthetically. This study compares subcuticular suture with staple closure regarding aesthetics of the neck scar.

Methods: This is a single-blinded comparative prospective controlled study with two cohorts in two hospitals. All consecutive patients who underwent one/two level ACS operation from 9/2015-8/2016 were screened. We excluded patients with postoperative wound infection, reoperation in the same admission, previous ACS operations, non-compliance in follow-up, and inability to give informed consent. We did single layer skin stapling without platysma closure or subcuticular suture with platysma closure. Patients were followed up at 1.5, 3, and 6 months. We used Stony Brook Scar Evaluation Scale (SBSES, 0-5) with 5 being the best score. Digital images were taken in a standardized manner and saved in a secure database. A blinded plastic surgeon and a blinded trained non-healthcare professional evaluated the scars using SBSES. A-priori sample size using a clinically significant difference of 1 was determined. Rank-sum test was used.

Results: In this interim analysis, we studied 94 staple and 47 suture closures. There is no significant difference between the groups regarding age, sex, rate of diabetes, smoking, obesity (BMI>30), chemotherapy, duration of surgery, and length of incision with significant difference regarding number of cervical levels. The mean interval of staple removal is 13.3 days. There is no significant difference regarding SBSES as evaluated by the plastic surgeon (staples vs. sutures, median 2 vs. 2, range 0-5, p = 0.63), or non-healthcare professional (staples vs. sutures, median 4 vs. 2, range 0-5, p = 0.4).

Conclusions: We demonstrated that staple and suture closure achieve equivalent aesthetic outcomes in ACS procedures when evaluated either by a plastic surgeon or a non-healthcare professional in interim analysis.

Patient Care: Staples instead of sutures in closure of anterior cervical spine entails less operative time, and an aesthetically equivalent scar.

Learning Objectives: We demonstrated that staple wound closure of anterior cervical spine incisions were equivalent to subcuticular suture closures. Staples are a faster, easier and more efficient way of closure, and can be more easily removed in case of an emergency. Therefore our study provides the spine surgeon another tool in the consideration of incision closure in the cervical spine procedures.

References: Quinn, J. et al. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann. Emerg. Med. 32, 645–649 (1998). 5. Iavazzo, C. et al. Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials. Am. Surg. 77, 1206–1221 (2011).