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Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: a prospective,
C C P Ong1, A S Jacobsen, V T Joseph
1Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. cong@kkh.com.sg
Insights
Tissue adhesive (2-octylcyanoacrylate) offers comparable cosmetic results and safety to subcuticular sutures for pediatric surgical incisions. However, it does not significantly reduce closure time compared to traditional suturing methods.
Area of Science:
- Pediatric Surgery
- Wound Closure Techniques
- Biomaterials
Background:
- Tissue adhesives are increasingly used for wound closure due to potential benefits in speed and pain reduction.
- Subcuticular sutures are a standard method for surgical incision closure in pediatric patients.
- Evaluating novel closure methods against established techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of 2-octylcyanoacrylate tissue adhesive versus subcuticular sutures for surgical incisions in children.
- To assess differences in time efficiency, cosmetic outcomes, and wound complications between the two closure methods.
- To evaluate parent satisfaction with the cosmetic appearance of wounds closed by either method.
Main Methods:
- A prospective, randomized, controlled trial was conducted in an ambulatory surgery center.
- Healthy pediatric patients undergoing herniotomies were randomly assigned to either tissue adhesive or subcuticular suture closure.
- Outcomes measured included wound closure time, cosmetic assessment using the Hollander wound score, and parent satisfaction via visual analogue scale (VAS).
Main Results:
- No statistically significant difference was found in mean wound closure time between the tissue adhesive group (181 ± 62 s) and the suture group (161 ± 45 s; P = 0.18).
- Cosmetic outcomes, assessed by a blinded observer using the Hollander wound score, were comparable, with similar rates of suboptimal scores (7.7% glue vs. 6.1% suture).
- Parent satisfaction (VAS scores: 78 ± 19 mm for glue vs. 81 ± 15 mm for suture; P = 0.68) and complication rates (no infections, rashes, or dehiscence) were equivalent between groups.
Conclusions:
- 2-octylcyanoacrylate tissue adhesive provides a safe and effective alternative for pediatric surgical incision closure with comparable cosmetic results to subcuticular sutures.
- While easy to use and complication-free, tissue adhesive does not offer a significant time advantage over subcuticular suturing in this pediatric surgical setting.
- Both tissue adhesives and subcuticular sutures are viable options for pediatric wound closure, with similar aesthetic and safety profiles.
Abstract:
Tissue adhesives have gained favour for quicker and painless closure of lacerations. To compare the tissue adhesive 2-octylcyanoacrylate with our current standard subcuticular suture for closure of surgical incisions in children, looking at outcome measures of time efficiency, cosmesis, and wound complications, a prospective, randomised, controlled trial was conducted at our institution's ambulatory surgery centre. All healthy patients undergoing unilateral or bilateral herniotomies were recruited prospectively with informed consent and randomly allocated to suture or glue. The exclusion criteria were neonates or children with allergy to tissue glue. Time of wound closure was measured from the subcutaneous layer to application of the dressing. An independent, blinded observer assessed cosmesis at 2 to 3 weeks using a validated wound scale ranging from worst (0) to best (6). Parent satisfaction with wound appearance was recorded on a 100-mm visual analogue scale (VAS). A total of 59 patients were recruited into the study with 26 in the glue group and 33 in the suture group. There was no difference in mean time of closure (glue 181 +/- 62 s vs suture 161 +/- 45 s, P = 0.18). Two patients in each group had a suboptimal Hollander wound score of 5 (7.7% glue, 6.1% suture). There was also no difference in parent satisfaction (VAS: glue 78 +/- 19 mm vs suture 81 +/- 15 mm, P = 0.68). No patient reported any rash, wound infection, or dehiscence. Tissue glue is easy to use with no complications and has equivalent cosmetic results, but is not faster than a subcuticular suture.