Comparison of cosmetic appearances after facial lacerations repaired by junior residents and experts

Am J Emerg Med. 2019 May;37(5):817-822. doi: 10.1016/j.ajem.2018.07.044. Epub 2018 Jul 24.


Purpose: The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training.

Methods: Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5-10 days following suturing.

Results: Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2-4) and 5 (4-5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001).

Conclusions: There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement.

Keywords: Education; Emergency department management; Teaching; Training; Wounds.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cicatrix / prevention & control*
  • Clinical Competence
  • Debridement / education
  • Emergency Medicine / education
  • Emergency Service, Hospital / statistics & numerical data
  • Facial Injuries / pathology
  • Facial Injuries / surgery*
  • Female
  • Humans
  • Internship and Residency*
  • Lacerations / pathology
  • Lacerations / surgery*
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Suture Techniques / education*