Evaluation of the effect of the accordion suturing technique on wound lengths in breast cancer surgery: a randomised clinical trial

  • Michael Ita
  • Kevin Koh
  • Abeeda Butt
  • Shaheed KaimKhani
  • Louise Kelly
  • Martin J. O’Sullivan
  • Henry Paul Redmond
  • Mark A. Corrigan
Original Article



Cosmetic outcomes and scar lengths remain important considerations in breast cancer surgery. Suturing techniques should decrease scar tissue formation and provide good cosmetic results. The use of an accordion suturing technique may result in decreased surgical wound lengths and better cosmetic outcomes. We compared the outcomes of the accordion suturing technique with the standard suturing technique in breast cancer surgeries.

Materials and methods

Female patients undergoing wide local excision of breast cancers were randomised to undergo closure of their surgical wound by either the accordion or the non-accordion (standard) suturing techniques between the months of May and October 2015. Pre-closure and post-closure wound lengths were measured intra-operatively. The primary outcome was a reduction of the surgical wound length at 6 weeks. The secondary outcome was a composite of the absence of hypertrophic scar tissue formation and optimal cosmesis.


Thirty eligible women for wide local excision of breast tumours were randomly assigned to the accordion and non-accordion groups (15 accordion and 15 non-accordion). Seven women were excluded from the study because they underwent re-excision of margins for their breast tumours before the end of 6 weeks, and one woman was lost to follow-up. We therefore compared the outcomes of 12 women who underwent closure of their surgical wound by way of the accordion suturing technique to the outcomes of 10 women who underwent closure with the non-accordion (standard) suturing technique. The percentage reduction of wound length at 6 weeks was significantly greater in the accordion group than in the non-accordion group (M = 24.4, SD = 10.2 vs. M = 8.6, SD = 11.5, p = 0.0026). There was no significant difference in the cosmetic outcome between both groups using the James Quinn’s wound evaluation score.


The accordion suturing technique was associated with a significant reduction in surgical wound lengths in breast conserving surgery at 6 weeks without compromising the cosmetic result.


Accordion suturing technique Cosmesis Wound length 



I wish to thank Professor Henry Paul Redmond, Professor Mark Corrigan and other staff of the department of Academic Surgery Cork University Hospital for their assistance and support in carrying out this study.

Authors’ contributions

IM and KK were responsible for study design, data analysis and interpretation. IM was responsible for writing the manuscript.

Compliance with ethical standards

Ethics approval and consent to participate

Ethical approval was obtained from the Clinical Research Ethics Committee at Cork University Hospital, Ireland, under license from the Department of Health and Children of the Republic of Ireland.

Consent for publication

Consent for publication was obtained from all participating patients.

Competing interests

The authors declare that they have no competing interests.

Supplementary material

11845_2018_1772_MOESM1_ESM.doc (167 kb)
ESM 1 (DOC 167 kb)


  1. 1.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMedGoogle Scholar
  2. 2.
    Hollander JE, Singer AJ (1999) Laceration Management. Ann Emerg Med 34(3):356–367CrossRefPubMedGoogle Scholar
  3. 3.
    Quinn JV, Wells GA (1998) An assessment of clinical wound evaluation scales. Acad Emerg Med 5(6):583–586CrossRefPubMedGoogle Scholar
  4. 4.
    Van der Wal MBA, Tuinebreijer WE, Bloemen MCT, Verhaegen P, Middelkoop E, van Zuijlen PPM (2012) Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Qual Life Res 21(1):13–23CrossRefPubMedGoogle Scholar
  5. 5.
    Van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg 116(2):514–522CrossRefPubMedGoogle Scholar
  6. 6.
    Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965CrossRefPubMedGoogle Scholar
  7. 7.
    Patterson MP, Pezner RD, Hill LR, Vora NL, Desai KR, Lipsett JA (1985) Patient self-evaluation of cosmetic outcome of breast-preserving cancer treatment. Int J Radiat Oncol Biol Phys 11(10):1849–1852CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Cork Breast Cancer Research CentreCork University HospitalCorkIreland
  2. 2.Department of Academic SurgeryUniversity College CorkCorkIreland

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