Effect of cross-running polypropylene intradermal suture technique on keloid scar: a single-blind randomized controlled trial

Main Article Content

Herman Yosef Limpat Wihastyoko
Edith Sumaregita Rinhastyanti
Arviansyah Arviansyah
Yudi Siswanto
Wilma Agustina
Elisabeth Prajanti Sintaningrum

Abstract

BACKGROUND
Keloids are abnormal scars that present a therapeutic challenge. Various treatment modalities have been developed, including surgical excision. While cross-running intradermal sutures were previously created using absorbable polyglycolic acid, this study introduces a modification using a non-absorbable material. Therefore, this study aimed to evaluate the effect of the cross-running polypropylene intradermal suture (CR-PIS) technique compared to the simple interrupted suture technique on keloid repair.


METHODS
This was a randomized controlled trial with a post-test-only design involving 30 male and female keloid patients aged 20-50 years. Participants were randomized into the treatment group (n=15) and the control group (n=15). Wound assessment using the Vancouver Scar Scale (VSS), Manchester Scar Scale (MSS), and Patient and Observer Scar Assessment Scale (POSAS) was performed at 3, 6, and 9 months after surgery. Differences in VSS, MSS, and POSAS scores between the CR-PIS group and the simple knot group were analyzed using the Mann-Whitney U test.


RESULTS
Statistical analysis revealed a significant difference between the simple knot and CR-PIS groups (p<0.05). The median scores for each assessment (VSS, MSS, and POSAS) decreased significantly at 3, 6, and 9 months, with the control group's values being higher than those in the CR-PIS group (p<0.05). These results indicate that the control group developed moderate scars, whereas the treatment group exhibited good scars.


CONCLUSIONS
The CR-PIS is more effective than the simple knot technique in improving keloid scars, as shown by changes in wound appearance, morphological function, topography, and patient and evaluator assessments.

Article Details

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Original Articles

How to Cite

Effect of cross-running polypropylene intradermal suture technique on keloid scar: a single-blind randomized controlled trial. (2026). Universa Medicina, 45(1), 4-12. https://doi.org/10.18051/UnivMed.2026.v45.4-12

References

1. Azzahra AM, Perdanakusuma DS, Indramaya DM, Saputro ID. Keloid and hypertrophic scar post-excision recurrence: a retrospective study. J Plastik Rekonstruksi 2022;9:58-63. Doi: 10.14228/jprjournal.v9i2.343.

2. Wilkinson HN, Hardman MJ. Wound healing: cellular mechanisms and pathological outcomes. Open Biol 2020;10:200223. Doi: 10.1098/rsob.200223.

3. Ogawa R, Dohi T, Tosa M, Aoki M, Akaishi S. The latest strategy for keloid and hypertrophic scar prevention and treatment: the Nippon Medical School (NMS) protocol. J Nippon Med Sch 2021;88:2-9. Doi: 10.1272/jnms.JNMS.2021_88-106.

4. Wihastyoko HY, Wuryanjono WP. The effectiveness of intradermal suture technique on hypertrophic scar prevention in rats. J Plastik Rekonstruksi 2022;9:24-9. DOI: 10.14228/jprjournal.v9i1.335.

5. Betarbet U, Blalock TW. Keloids: a review of etiology, prevention, and treatment. J Clin Aesthet Dermatol 2020;13:33-43.

6. Marshall CD, Hu MS, Leavitt T, Barnes LA, Lorenz HP, Longaker MT. Cutaneous scarring: basic science, current treatments, and future directions. Adv Wound Care (New Rochelle) 2018;7:29-45. Doi: 10.1089/wound . 2016.0696.

7. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plastic Reconstr Surg 2022;149:79e-94e. DOI: 10.1097/PRS.0000000000008667.

8. Rohani MG, Parks WC. Matrix remodeling by MMPs during wound repair. Matrix Biol 2015;44-46:113-21. doi: 10.1016/j.matbio.2015.03.002.

9. Ghazawi FM, Zargham R, Gilardino MS, Sasseville D, Jafarian F. Insights into the pathophysiology of hypertrophic scars and keloids: how do they differ?. Adv Skin Wound Care 2018;31:582-95. Doi: 10.1097/01.ASW.0000527576.27489.0f.

10. Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. Hypertrophic scars and keloids: Overview of the evidence and practical guide for differentiating between these abnormal scars. Exp Dermatol 2021;30:146-61. DOI: 10.1111/exd. 14158.

11. Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. The keloid disorder: heterogeneity, histopathology, mechanisms and models. Front Cell Dev Biol 2020;8:360. Doi: 10.3389/fcell. 2020.00360.

12. Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci 2023;18:606. doi: 10.3390/ijms18030606.

13. Pontoriero A, Potami A, Iatì G, et al. Post-operative radiotherapy of keloids: a 10-years experience of kilovoltage irradiation. Int J Radiat Res 2015;13:201-4. doi: 10.7508/ijrr.2015.03.001.

14. Andisi RD, Suling PL, Kapantow MG. Profil keloid di poliklinik kulit dan kelamin RSUP Prof. Dr. RD Kandou Manado periode Januari 2011-Desember 2015. [Keloid profile at the Dermato-Venereology Polyclinic of Prof. Dr. RD Kandou Central General Hospital, Manado, for January 2011 - December 2015]. E-CliniC. 2016;4:6 pages. DOI: 10.35790/ecl.v4i2.14667. Indonesian.

15. Wardani FA, Peradanakusuma DS, Indramaya DM. Profile of working-age patients with keloid and hypertrophic scar at Dr. Soetomo General Hospital Surabaya in 2014-2017. JUXTA: J Ilmiah Mahasiswa Kedokteran Universitas Airlangga 2021;12:77. DOI: 10.20473/juxta.V12I22021.77-83.

16. Deflorin C, Hohenauer E, Stoop R, Van Daele U, Clijsen R, Taeymans J. Physical management of scar tissue: a systematic review and meta-analysis. J Altern Complement Med 2020;26:854-65. DOI: 10.1089/acm. 2020.0109.

17. Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, Kuokkanen HO, Kaartinen IS. Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections–a randomized controlled trial. J Plast Reconstr Aesthet Surg 2019;72:4-11. DOI: 10.1016/j.bjps.2018.05.052.

18. Liu EK, Cohen RF, Chiu ES. Radiation therapy modalities for keloid management: a critical review. J Plast Reconstr Aesthet Surg 2022;75: 2455-65. doi: 10.1016/j.bjps.2022.04.099.

19. Zhang Y, Xuwen TA, Yang LI, Dongyun YA. Treatment of keloids in a child with surgery alone: clinical application of the LBD suturing technique. Chin J Plast Reconstr Surg 2021;3:46-50. DOI: 10.1016/S2096-6911(21)00078-9.

20. Xiong L, Sun J, Pan Q, Yang J. The cross-running intradermal suture: a novel method for incision closure. Facial Plast Surg 2012;28:541-2. DOI: 10.1055/s-0032-1325650.

21. Ario D, Wihasetyoko HY, Susilo H. Intradermal suture effect using polypropylene materials on post-operative scar tissue in cases of lower extremities closed fracture cases. Bali Med J 2019;8:4. DOI: 10.15562/bmj.v8i3.1556.

22. de Romero BC, Romero MPM, Zuluaga NM, Gómez GL. Oral post-surgical healing with polyglycolic acid suture. Open Access Res J Biol Pharmacy 2022;05:82–7. DOI: 10.53022/oarjbp.2022.5.2.0056.

23. Devi CHRV, Ray R, Koduri S, Moharana AK, Deepak TS. Clinical equivalence of polyglycolic acid suture and polyglactin 910 suture for subcutaneous tissue closure after cesarean delivery: a single-blind randomized study. Med Devices (Auckl) 2023;16:27-36. DOI: 10.2147/MDER.S385988.

24. Shin HY, Park YJ, Choi WK, et al. Assessment of treatment modalities in patients with keloids: a Vancouver scale comparison. Ann Dermatol 2024;36:348. Doi: 10.5021/ad.23.160.

25. Abelleyra Lastoria DA, Benny CK, Hing CB. Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: a systematic review of the literature. Chinese J Traumatol 2023;26:276-83. Doi: 10.1016/j.cjtee.2023.02.001.

26. Carrière ME, Mokkink LB, Pleat J, et al. Development of the observer scales of the patient and observer scar assessment scale: an international Delphi study. Plast Reconstr Surg–Global Open 2025;13:e6416. DOI: 10.1097/GOX.0000000000006416.

27. Grabowski G, Pacana MJ, Chen E. Keloid and hypertrophic scar formation, prevention, and management: standard review of abnormal scarring in orthopaedic surgery. J Am Acad Orthop Surg 2020;28:e408-14. DOI: 10.5435/JAAOS-D-19-00690.

28. Luo W, Tao Y, Wang Y, Ouyang Z, Huang J, Long X. Comparing running vs interrupted sutures for skin closure: a systematic review and meta‐analysis. Int Wound J 2023;20:210-20. DOI: 10.1111/iwj.13863.

29. Gouletsou PG, Zacharopoulou T, Skampardonis V, et al. First-intention incisional wound healing in dogs and cats: a controlled trial of dermapliq and manuka honey. Vet Sci 2024;11:64. DOI: 10.3390/vetsci11020064.

30. Ogawa R, Akaishi S, Huang C, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch 2011;78:68-76. DOI: 10.1272/jnms.78.68.

31. Gong F, Wan B, Qi P, Wei Z. Biomechanical mechanism and clinical management progress of surgical wound tension. Front Surg 2025;12: 1674382. DOI: 10.3389/fsurg. 2025.1674382.

32. Alves de Oliveira M, Arcanjo A, Castro F, Fernandes JCH, Fernandes GVO. Evaluating and comparing the tensile strength and clinical behavior of monofilament polyamide and multifilament silk sutures: a systematic review. Surgeries 2024;5:350-66. DOI: 10.3390/surgeries5020029.