Tissue adhesive works as well as suturing

ABSTRACT

BACKGROUND: Although suturing is the most common method of wound closure, it requires injection of an anesthetic, is time-consuming, carries the risk of a needle stick to the clinician, and requires a return visit for suture removal. Tissue adhesives applied to skin hold wound edges together and usually slough off within 5 to 10 days without requiring removal. This study compared an easy-to-use, topical adhesive, octylcyanoacrylate to standard wound closure methods (sutures, staples, or adhesive tapes).

POPULATION STUDIED: This multicenter study enrolled 814 patients (924 wounds) from emergency departments, an urgent care clinic, outpatient surgery centers, and private practices. Patients had to be in good health (without insulin-dependent diabetes, peripheral vascular disease, bleeding diathesis, multiple trauma, or possibility of keloid formation) and older than 1 year. Wounds that could be repaired with 5-0 or smaller suture were eligible. Bites, puncture wounds, infected wounds, decubitus ulcers, stellate lacerations, wounds located on the vermilion border of the lip or mucosa, and wounds over flexor or extensor surfaces or near the eye were excluded. Seventy percent of the subjects were white and the mean wound length was approximately 2 cm.

STUDY DESIGN AND VALIDITY: Eligible subjects were randomized using computer-generated random numbers and opaque envelopes (concealed allocation assignment) to receive either octylcyanoacrylate or standard wound closure. Although blinding patients or physicians to treatment was not possible, personnel assessing the outcomes at 3 months were blind to treatment group assignment. No baseline differences were noted between treatment groups. Patients were analyzed in the groups to which they were randomized (intention-to-treat analysis) and follow-up was complete (96% at 1 week and 94% at 3 months). This study had adequate power (90%) to detect a difference (10%) in the proportion of patients with optimal wound appearance, but was underpowered to detect a small difference in infection or dehiscence rates.

OUTCOMES MEASURED: The primary outcome measured was cosmetic wound appearance. Other outcomes included wound closure time, infection rates, and dehiscence rates.

RESULTS: At 3 months no difference was noted in the percentage of wounds with optimal appearance (octylcyanoacrylate, 82% vs standard wound closure, 83%; P = .67). Although wound closure with octylcyanoacrylate was faster than with standard wound closure (mean 2.9 vs 5.2 minutes, P < .001), this small difference is probably not clinically significant. Infection rates were similar (octylcyanoacrylate, 2.1% vs standard wound closure, 0.7%; P = .09), as were dehiscence rates (octylcyanoacrylate, 1.6% vs standard wound closure, 0.9%; P = .67).

ABSTRACT

BACKGROUND: Although suturing is the most common method of wound closure, it requires injection of an anesthetic, is time-consuming, carries the risk of a needle stick to the clinician, and requires a return visit for suture removal. Tissue adhesives applied to skin hold wound edges together and usually slough off within 5 to 10 days without requiring removal. This study compared an easy-to-use, topical adhesive, octylcyanoacrylate to standard wound closure methods (sutures, staples, or adhesive tapes).

POPULATION STUDIED: This multicenter study enrolled 814 patients (924 wounds) from emergency departments, an urgent care clinic, outpatient surgery centers, and private practices. Patients had to be in good health (without insulin-dependent diabetes, peripheral vascular disease, bleeding diathesis, multiple trauma, or possibility of keloid formation) and older than 1 year. Wounds that could be repaired with 5-0 or smaller suture were eligible. Bites, puncture wounds, infected wounds, decubitus ulcers, stellate lacerations, wounds located on the vermilion border of the lip or mucosa, and wounds over flexor or extensor surfaces or near the eye were excluded. Seventy percent of the subjects were white and the mean wound length was approximately 2 cm.

STUDY DESIGN AND VALIDITY: Eligible subjects were randomized using computer-generated random numbers and opaque envelopes (concealed allocation assignment) to receive either octylcyanoacrylate or standard wound closure. Although blinding patients or physicians to treatment was not possible, personnel assessing the outcomes at 3 months were blind to treatment group assignment. No baseline differences were noted between treatment groups. Patients were analyzed in the groups to which they were randomized (intention-to-treat analysis) and follow-up was complete (96% at 1 week and 94% at 3 months). This study had adequate power (90%) to detect a difference (10%) in the proportion of patients with optimal wound appearance, but was underpowered to detect a small difference in infection or dehiscence rates.

OUTCOMES MEASURED: The primary outcome measured was cosmetic wound appearance. Other outcomes included wound closure time, infection rates, and dehiscence rates.

RESULTS: At 3 months no difference was noted in the percentage of wounds with optimal appearance (octylcyanoacrylate, 82% vs standard wound closure, 83%; P = .67). Although wound closure with octylcyanoacrylate was faster than with standard wound closure (mean 2.9 vs 5.2 minutes, P < .001), this small difference is probably not clinically significant. Infection rates were similar (octylcyanoacrylate, 2.1% vs standard wound closure, 0.7%; P = .09), as were dehiscence rates (octylcyanoacrylate, 1.6% vs standard wound closure, 0.9%; P = .67).

ABSTRACT

BACKGROUND: Although suturing is the most common method of wound closure, it requires injection of an anesthetic, is time-consuming, carries the risk of a needle stick to the clinician, and requires a return visit for suture removal. Tissue adhesives applied to skin hold wound edges together and usually slough off within 5 to 10 days without requiring removal. This study compared an easy-to-use, topical adhesive, octylcyanoacrylate to standard wound closure methods (sutures, staples, or adhesive tapes).

POPULATION STUDIED: This multicenter study enrolled 814 patients (924 wounds) from emergency departments, an urgent care clinic, outpatient surgery centers, and private practices. Patients had to be in good health (without insulin-dependent diabetes, peripheral vascular disease, bleeding diathesis, multiple trauma, or possibility of keloid formation) and older than 1 year. Wounds that could be repaired with 5-0 or smaller suture were eligible. Bites, puncture wounds, infected wounds, decubitus ulcers, stellate lacerations, wounds located on the vermilion border of the lip or mucosa, and wounds over flexor or extensor surfaces or near the eye were excluded. Seventy percent of the subjects were white and the mean wound length was approximately 2 cm.

STUDY DESIGN AND VALIDITY: Eligible subjects were randomized using computer-generated random numbers and opaque envelopes (concealed allocation assignment) to receive either octylcyanoacrylate or standard wound closure. Although blinding patients or physicians to treatment was not possible, personnel assessing the outcomes at 3 months were blind to treatment group assignment. No baseline differences were noted between treatment groups. Patients were analyzed in the groups to which they were randomized (intention-to-treat analysis) and follow-up was complete (96% at 1 week and 94% at 3 months). This study had adequate power (90%) to detect a difference (10%) in the proportion of patients with optimal wound appearance, but was underpowered to detect a small difference in infection or dehiscence rates.

OUTCOMES MEASURED: The primary outcome measured was cosmetic wound appearance. Other outcomes included wound closure time, infection rates, and dehiscence rates.

RESULTS: At 3 months no difference was noted in the percentage of wounds with optimal appearance (octylcyanoacrylate, 82% vs standard wound closure, 83%; P = .67). Although wound closure with octylcyanoacrylate was faster than with standard wound closure (mean 2.9 vs 5.2 minutes, P < .001), this small difference is probably not clinically significant. Infection rates were similar (octylcyanoacrylate, 2.1% vs standard wound closure, 0.7%; P = .09), as were dehiscence rates (octylcyanoacrylate, 1.6% vs standard wound closure, 0.9%; P = .67).