A Wayne State University School of Medicine student captured a first place award for Clinical Research at the American College of Surgeons Clinical Congress.

Diana Kakos, a second-year medical student, won the ACS Clinical Congress Medical Student Program Poster Session for “Aesthetic Comparison Between Subcuticular Suture and Staple Closure of Anterior Cervical Spine (ACS) Incision Scars: A Prospective Controlled Single-Blinded Clinical Trial.”

Anterior cervical spine procedures make up a significant portion of the clinical caseloads of neurosurgeons and orthopedic spine surgeons, explained Kakos, of Bloomfield Hills, Mich. Any procedure of the head and neck will have greater scrutiny of scar appearance, as it will be readily apparent to the patient and observers for the rest of their lives. Closure of the postoperative incision can be performed in many ways.

This was 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. The researchers 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. The researchers 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.

In this interim analysis, The researchers studied 94 staple and 47 suture closures. There was no significant difference between the groups regarding age, sex, rate of diabetes, smoking, obesity (BMI<30), chemotherapy, length of incision. 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).

“Our study sought to objectively compare subcuticular suture closure with staple closure as related to postoperative aesthetic appearance. We found that staples and sutures provide equivalent aesthetic outcomes per evaluation by a plastic surgeon, using a validated outcome measure,” Kakos said. “This study gives aesthetic outcome of closure technique objectivity and allows the surgeon to choose his or her technique of closure with confidence in equivalency of aesthetic outcome.”

Kakos, who is not yet sure what field of medicine she wants to enter after graduation, also presented the research during the WSU School of Medicine Student Research Symposium, but her presentation at the Congress was the first time she presented the final results and analysis.