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A Prospective Controlled Study on Long-Term Outcomes of Facial Lacerations in Children
Sonja Fontana1,2, Clemens M Schiestl2,3, Markus A Landolt2,4
1Department of Pediatric Emergency Medicine, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Skin adhesives offer better cosmetic outcomes and are more cost-effective for wound closure compared to sutures. While early dehiscence rates were higher with adhesives, long-term results were comparable, with rare complications for both methods.
Area of Science:
- Plastic Surgery
- Wound Healing
- Dermatology
Background:
- Skin adhesives have a long history of use for laceration repair, but long-term efficacy and complication rates require further investigation.
- Existing literature presents mixed findings on the comparative effectiveness of skin adhesives versus traditional suturing techniques for wound closure.
Purpose of the Study:
- To prospectively compare the long-term aesthetic outcomes and complication rates of skin adhesives versus sutures for skin laceration repair.
- To evaluate secondary outcomes including pain, anesthesia requirements, treatment time, costs, and quality of life.
Main Methods:
- A prospective, controlled, single-blinded, observational cohort study involving 230 patients with lacerations.
- Wound closure was achieved using either tissue adhesives (n=96) or sutures (n=134).
- Outcomes were assessed by independent plastic surgeons and patients/caregivers using modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) at 6-12 months, alongside other clinical and patient-reported measures.
Main Results:
- Independent observers reported significantly better scar assessment scores (modified POSAS and VSS) for the tissue adhesive group compared to the suture group (p < 0.001).
- Early wound dehiscence rates were higher in the adhesive group (12.5% vs. 3.7%), but this difference diminished over time.
- Tissue adhesives demonstrated reduced treatment time and lower costs, with comparable long-term quality of life outcomes and rare overall complications for both methods.
Conclusions:
- Both skin adhesives and sutures provide favorable aesthetic results and have low complication rates for skin laceration repair.
- Tissue adhesives present significant advantages due to their cost-effectiveness and reduced application time, making them a valuable option when used appropriately.
- Further research may explore patient selection criteria to optimize outcomes with skin adhesive use.
Abstract:
Background: Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications. Methods: In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6-12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed. Results: A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97-2.25] vs. 2.5, 95% CI [2.39-2.63]; p < 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981-1.34] vs. 1.6, 95% CI [1.49-1.79], p < 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p < 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1. Conclusion: Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately. Trial Registration: Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).
