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Cosmetic Outcomes of Simple Pediatric Facial Lacerations Repaired With Skin Adhesive Compared With Skin Adhesive With
Erin Munns, Andrew J Kienstra, Patrick D Combs1
1Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School.
Insights
For pediatric facial lacerations, using skin adhesive with underlying adhesive strips offers similar cosmetic outcomes to skin adhesive alone. This method, however, takes longer to perform but may be useful when manual wound approximation is challenging.
Area of Science:
- Pediatric Emergency Medicine
- Wound Repair Techniques
- Dermatologic Surgery
Background:
- Simple pediatric facial lacerations are common in emergency departments.
- Assessing optimal repair methods for cosmetic outcomes is crucial for pediatric patients.
- Skin adhesive and adhesive strips are commonly used wound closure materials.
Purpose of the Study:
- To compare the cosmetic outcomes of simple pediatric facial lacerations repaired with skin adhesive alone versus skin adhesive with underlying adhesive strips.
- To evaluate short-term complications and procedural time for both repair methods.
Main Methods:
- A randomized controlled trial enrolled pediatric patients (<18 years) with simple facial lacerations.
- Patients were randomized to receive either skin adhesive alone or skin adhesive with underlying adhesive strips.
- Cosmetic outcomes were assessed at 2 months using a visual analog scale by blinded pediatric specialists.
Main Results:
- No significant difference in cosmetic outcome (visual analog scale scores: 60 mm vs 58 mm, P=0.540) was observed between the two groups.
- Both methods showed similar rates of return visits, wound dehiscence, and infection.
- The addition of adhesive strips significantly increased the repair time (195 seconds vs 107 seconds, P < 0.001).
Conclusions:
- Skin adhesive with underlying adhesive strips provides comparable cosmetic results to skin adhesive alone for simple pediatric facial lacerations.
- While increasing procedural time, this combined approach may be beneficial in cases where manual wound approximation is difficult.
- Further research could explore patient and parent satisfaction with each method.
Objectives:
A randomized controlled trial was designed to compare 2 methods of repairing simple pediatric facial lacerations. We hypothesized that wounds repaired with skin adhesive and underlying adhesive strips compared with skin adhesive alone would be superior in regard to cosmetic outcome.
Methods:
Patients aged younger than 18 years presenting to the emergency department with simple facial lacerations requiring repair were eligible for enrollment. Patients were randomly assigned to repair with either skin adhesive alone or skin adhesive with underlying adhesive strips. Families were contacted by phone 1 week after enrollment to discuss short-term complications. The cosmetic appearance of photographs of the scars at 2 months was analyzed using a visual analog scale by a blinded pediatric emergency physician and pediatric plastic surgeon.
Results:
One hundred twenty patients were enrolled, with 92 returning for the 2-month follow-up. The visual analog scale scores for the skin adhesive with adhesive strips group were similar to the skin adhesive alone group (60 mm vs 58 mm, P = 0.540). Spearman ρ correlation coefficient between the raters was 0.669, indicating strong agreement. There was no significant difference in rates of return visits, wound dehiscence, or infection. The skin adhesive with adhesive strips group had a longer time to perform the repair (195 seconds vs 107 seconds, P < 0.001).
Conclusions:
Using adhesive strips to first approximate a wound before applying skin adhesive leads to a similar cosmetic outcome compared with simple facial lacerations repaired with skin adhesive alone. Although the study showed longer time to complete the repair, this approach may still be useful in settings where approximation is difficult to obtain manually.
