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Lacerations against Langer's lines: to glue or suture?
H K Simon1, W T Zempsky, T B Bruns
1Department of Pediatrics, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Facial laceration repair using histoacryl blue (HAB) tissue adhesive resulted in better cosmetic outcomes, especially for wounds not aligned with Langer's Lines, compared to traditional suturing.
Area of Science:
- Plastic Surgery
- Dermatology
- Wound Healing
Background:
- Facial lacerations require careful repair to optimize cosmetic outcomes.
- The orientation of a laceration relative to Langer's Lines can influence healing and final appearance.
- Histoacryl Blue (HAB) is a tissue adhesive used for wound closure.
Purpose of the Study:
- To evaluate the impact of initial wound orientation on the cosmetic outcome of facial lacerations.
- To compare the cosmetic results of facial lacerations repaired with Histoacryl Blue (HAB) versus conventional suturing.
- To determine if HAB offers an advantage for lacerations not aligned with Langer's Lines.
Main Methods:
- Retrospective analysis of patients from a prospective randomized clinical trial.
- Facial lacerations were categorized based on orientation to Langer's Lines (Langer (+) or Langer (-)).
- Cosmetic appearance was assessed at 2-month follow-up using a visual analog scale by blinded plastic surgeons.
Main Results:
- No significant difference in cosmetic appearance between HAB and suturing for all wounds.
- Sutured wounds not aligned with Langer's Lines (Langer (-)) had significantly worse cosmetic outcomes than those aligned (Langer (+)).
- Cosmetic outcomes for HAB-repaired wounds were comparable between Langer (-) and Langer (+) orientations.
Conclusions:
- Initial wound orientation significantly impacts cosmetic outcomes for sutured facial lacerations.
- Histoacryl Blue (HAB) demonstrated comparable cosmetic results regardless of wound orientation.
- HAB may be the preferred method for facial lacerations oriented against Langer's Lines to improve cosmetic results.
Abstract:
This study evaluated the effects of initial wound orientation on the cosmetic outcome of facial lacerations repaired with histoacryl blue (HAB), a tissue adhesive, vs. conventional suturing. This was a retrospective analysis of patients from a prospective randomized clinical trial on the use of HAB. Children in the initial cohort who had facial lacerations and were also evaluated for cosmetic appearance at a 2-month follow-up appointment were eligible. Orientation along Langer's Lines, which define the functional anatomy of the underlying structures to the skin, was determined by two investigators blinded to the initial method of repair. Photographs of the wounds were reviewed and the wounds were categorized as being: Langer (+) (<20 degrees deviated from Langer's Lines) or Langer (-) (> or =20 degrees deviated from Langer's Lines). Photographic appearance at follow-up was evaluated using a 100-mm visual analog scale (0=best, 100=worst) by two plastic surgeons blinded to the method of repair. Sixty-one patients were enrolled in the initial cohort, with 55 (90%) evaluated at the 2-month follow-up. Forty-eight of the 55 (87%) had facial lacerations, therefore meeting present study criteria: [HAB (n=26), Suturing (n=22), Langer (+) (n=27), Langer (-) (n=21)]. Langer (+) patients were comparable to Langer (-) for demographics, wound characteristics, and method of repair. There was no difference in overall cosmetic appearance of facial wounds closed with HAB vs. conventional suturing. Follow-up appearance was significantly worse for sutured Langer (-) vs. Langer (+) wounds. In contrast, cosmetic appearance of lacerations closed by HAB were comparable between Langer (-) and Langer (+) wounds. In conclusion, initial wound orientation had a greater impact on the cosmetic appearance for lacerations closed by suturing compared to HAB. HAB may be the preferred method of cutaneous closure for facial lacerations oriented against Langer's Lines.
