Low-Tension Wound Closure Techniques
Date First Published:
July 17, 2026
Last Updated:
July 17, 2026
Report by:
Ahmad Ayyad MD, Jennifer Bach DO, Senior EM resident, EM faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, EM Research Director
Three-Part Question:
In [adult patients requiring sutured wound closure] do [low-tension closure techniques (continuous sutures, buried dermal tension-reducing methods) compared with standard interrupted or higher-tension closure techniques] improve [cosmesis and reduce wound complications]?
Clinical Scenario:
A patient presents to the emergency department with a simple leg laceration requiring sutured closure. Traditional teaching often emphasizes precise approximation and wound edge eversion to optimize healing and cosmetic outcome. However, increasing attention has been directed toward wound tension as a potentially more important determinant of scar formation and wound integrity. You wonder whether low-tension closure techniques improve healing outcomes compared with standard interrupted closure methods.
Search Strategy:
Medline 1966-06/26 using PubMed, Cochrane Library (2024), and Embase
Search Details:
[(“tension relieving suture” OR “tension reducing suture” OR “tension reduction technique” OR “low tension wound closure” OR “tension free closure”) AND ("suture techniques adverse effects”)]
(("wound infection"[All Fields]) AND ("Wound Healing"[MeSH])) AND ("Suture Techniques"[MAJR])
[("Suture Techniques"[MAJR]) AND ("cosmetic outcomes")]
(("wound infection"[All Fields]) AND ("Wound Healing"[MeSH])) AND ("Suture Techniques"[MAJR])
[("Suture Techniques"[MAJR]) AND ("cosmetic outcomes")]
Outcome:
271 papers were found; 5 answered the clinical question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparing running vs interrupted sutures for skin closure: a systematic review and meta-analysis Luo W, Tao Y, Wang Y, Ouyang Z, Huang J, Long X. Jan 2023 Beijing, China | 1181 participants that had either continuous sutures or interrupted sutures | 10 RCTS analyzing two different suture techniques for skin suture, continuous suture (both transdermal and subcutaneous) vs interrupted suture | Continuous sutures were compared with interrupted sutures on the basis of cosmesis, dehiscence, and infection rates. | Continuous sutures had higher visual analogue scale (VAS) scores for cosmesis among patients and doctors than interrupted sutures (OR = 0.27). There was no significant difference between the infection events rates of two suture methods (OR = 0.69). Subcutaneous continuous sutures were better in reducing the incidence of dehiscence events (OR = 0.16) | Included studies were heterogeneous with variation in wound type, closure location, and cosmetic assessment methods. Few studies specifically evaluated uncomplicated emergency department lacerations. |
| Application of Remote Buried Dermal Super-Tension-Reducing Sutures for Incisional Scar Prevention Yang D, Yao L, Zhan Y, Zeng W October 2025 People's Republic of China | 50 adult patients undergoing incisional closure for scar prevention. | RCT comparing a new super-tension-reducing suture method to traditional closure using interrupted sutures in patients undergoing oral and maxillofacial surgery. | Scar scores, incidence of pigmentation, “cobblestone” scars and delayed incision healing. | The average scar score in the observation group was 5.96 ± 2.03, significantly lower than the control group. Additionally, the observation group had significantly fewer complications including pigmentation (5.0% vs 70.4%, p < 0.001), “cobblestone” scars (0.0% vs 44.4%, p < 0.001), and delayed wound healing (0.0% vs 25.9%, p = 0.009). | Focused on elective surgical incisions rather than simple lacerations. scar formation assessments were examined at six months, and this time is too short for scar maturation. The sample size was small. |
| Clinical efficacy, postoperative complication risks, and parental satisfaction in pediatric patients receiving tension-reducing suture treatment for facial lacerations Mi Z, Zeng P, Yang W, Sun H, Yao P. Clinical efficacy, postoperative complication risks, and parental satisfaction in pediatric patients receiving tension-reducing suture treatment for facial lacerations. October 2025 China | 122 pediatric patients with facial lacerations | Retrospective cohort analysis comparing the tension-reducing suture group n = 61) and the conventional suture group (n = 61). | The two groups were compared regarding clinical efficacy, scar formation, postoperative complications, and parental satisfaction. | The primary healing rate (Grade A) in the tension-reducing suture group was 88.5%, significantly higher than that in the conventional suture group (73.8%). At 1 month postoperative, the Vancouver Scar Scale (VSS) scores in the tension-reducing suture group were significantly lower than those in the conventional suture group (p = 0.011). The postoperative complication rate was 4.9% in the tension-reducing suture group and 14.8% in the conventional suture group, with no statistically significant difference (p = 0.068). Parental overall satisfaction was 93.4% in the tension-reducing suture group and 80.3% in the conventional suture group, showing a statistically significant difference (p = 0.032). | Retrospective study; the study was underpowered to detect a statistically significant difference in wound complications; sample size included was relatively small; and duration of follow-up in this study was relatively short. |
| Investigating the Efficacy of Layered Moderate Tension Reduction Suturing in Facial Aesthetic Surgery Wang GH, Gang JY, Li Y. May 2025 People's Republic of China | 80 patients who underwent head and facial cosmetic and plastic surgery in the outpatient department | Retrospective study comparing the experimental group, which received the layer-by-layer moderate tension reduction suture technique, with the control group, which received the traditional suture technique. | The incidence of surgical complications, scar width, and scar quality metrics derived from the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores were compared between the two groups. | The experimental group had a longer operation time but no complications (0%), compared to the control group's 17.5% complication rate (P < 0.05). At one, three, six, and 12 months postoperatively, the experimental group had significantly smaller scar widths, lower POSAS scores, and lower VSS scores compared to the control group (all P < 0.05). | Retrospective; relatively small sample size; and limited follow-up duration. |
| Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar Chen J, Mo Y, Chen Y, Ma Z, Shen S, Sang H, Tan Q, Mo R. April 2024 China | 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery | Retrospective analysis comparing the tension-reducing suturing technique with the conventional suture method. | Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). | The tension-reducing suturing technique improved scar quality compared to that preoperatively, with a reduction in scar width (P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in every single parameter and total score compared to preoperative values (P < 0.05). | Retrospective: the scar scale used was not completely objective, and the sample size was small. |
Author Commentary:
Direct evidence evaluating low-tension closure techniques in adult uncomplicated lacerations remains limited. Available evidence suggests that reducing wound tension may improve cosmetic healing and reduce structural complications. Continuous suture techniques may provide modest cosmetic benefit and lower dehiscence rates compared with interrupted sutures. However, much of the strongest evidence supporting tension reduction comes from surgical incisions and high-tension wounds rather than uncomplicated emergency department lacerations.
Bottom Line:
Low-tension wound closure techniques appear biologically favorable and may modestly improve cosmetic outcomes and reduce wound complications compared with standard interrupted closure methods.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- 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
- Yang D, Yao L, Zhan Y, Zeng W. Application of Remote Buried Dermal Super-Tension-Reducing Sutures for Incisional Scar Prevention
- Mi Z, Zeng P, Yang W, Sun H, Yao P. Clinical efficacy, postoperative complication risks, and parental satisfaction in pediatric patients receiving tension-reducing suture treatment for facial lacerations.. Clinical efficacy, postoperative complication risks, and parental satisfaction in pediatric patients receiving tension-reducing suture treatment for facial lacerations
- Wang GH, Gang JY, Li Y.. Investigating the Efficacy of Layered Moderate Tension Reduction Suturing in Facial Aesthetic Surgery
- Chen J, Mo Y, Chen Y, Ma Z, Shen S, Sang H, Tan Q, Mo R.. Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar