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Cui X, Zhang Y, Wang N, Chen Y, Xu J, Hou J. The outcome of sutured wounds compared with tissue adhesive for paediatric wound closure: A meta-analysis. Int Wound J 2023; 20:3298-3306. [PMID: 37221969 PMCID: PMC10502276 DOI: 10.1111/iwj.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
A meta-analysis investigation was executed to measure the outcome of sutured wounds (SWs) compared with tissue adhesive (TA) for paediatric wound closure (PWC). A comprehensive literature inspection till February 2023 was applied and 2018 interrelated investigations were reviewed. The 18 chosen investigations enclosed 1697 children with PWC in the chosen investigations' starting point, 977 of them were utilising SWs, and 906 were utilising TA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of SWs compared with TA for PWC by the dichotomous approaches and a fixed or random model. SWs had significantly higher wound cosmetic (WC) scores (mean deviation [MD], 1.70; 95% CI, 0.57-2.84, P = .003), lower wound dehiscence (WD) (OR 0.60; 95% CI, 0.06-0.43, P < .001), and lower cost (MD, -10.22; 95% CI, -10.94 to -9.50, P < .001) compared with those with TA in PWC. No significant difference was found between children utilising SWs and TA in wound infection (WI) (OR, 0.45; 95% CI, 0.15-1.30, P = .14) with no heterogeneity (I2 = 0%) in PWC. SWs had significantly higher WC scores, lower WD, and lower cost, yet, no significant difference was found in WI compared with those with TA in PWC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations and the low number of selected investigations for the meta-analysis.
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Affiliation(s)
- Xiaomei Cui
- School of PediatricsHenan University of Traditional Chinese MedicineZhengzhouHenanChina
| | - Yuanbo Zhang
- Department of SurgeryThe Third Affiliated Hospital of Beijing University of Chinese MedicineBeijingChina
| | - Na Wang
- Institutes of Integrative MedicineFudan UniversityShanghaiChina
| | - Yafang Chen
- Department of PediatricsZhumadian Hospital of Traditional Chinese MedicineZhengzhouHenanChina
| | - Jin Xu
- Second School of Clinical MedicineThe Second Affiliated Hospital of Henan University of Chinese MedicineZhengzhouHenanChina
| | - Jianghong Hou
- Second School of Clinical MedicineThe Second Affiliated Hospital of Henan University of Chinese MedicineZhengzhouHenanChina
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Zinc-nutrient element based alloys for absorbable wound closure devices fabrication: Current status, challenges, and future prospects. Biomaterials 2021; 280:121301. [PMID: 34922270 DOI: 10.1016/j.biomaterials.2021.121301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/22/2023]
Abstract
The need for the development of load-bearing, absorbable wound closure devices is driving the research for novel materials that possess both good biodegradability and superior mechanical characteristics. Biodegradable metals (BMs), namely: magnesium (Mg), zinc (Zn) and iron (Fe), which are currently being investigated for absorbable vascular stent and orthopaedic implant applications, are slowly gaining research interest for the fabrication of wound closure devices. The current review presents an overview of the traditional and novel BM-based intracutaneous and transcutaneous wound closure devices, and identifies Zn as a promising substitute for the traditional materials used in the fabrication of absorbable load-bearing sutures, internal staples, and subcuticular staples. In order to further strengthen Zn to be used in highly stressed situations, nutrient elements (NEs), including calcium (Ca), Mg, Fe, and copper (Cu), are identified as promising alloying elements for the strengthening of Zn-based wound closure device material that simultaneously provide potential therapeutic benefit to the wound healing process during implant biodegradation process. The influence of NEs on the fundamental characteristics of biodegradable Zn are reviewed and critically assessed with regard to the mechanical properties and biodegradability requirements of different wound closure devices. The opportunities and challenges in the development of Zn-based wound closure device materials are presented to inspire future research on this rapidly growing field.
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Applying Unsterile Microporous Tape onto Surgical Wounds: Tape Contamination and Clinical Rationale. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3635. [PMID: 34150428 PMCID: PMC8205218 DOI: 10.1097/gox.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
Fomites are surfaces that carry contaminants and may cause infection. We wanted to assess the bacterial load on rolls of nonsterile microporous tape in a hospital setting and explore the scientific rationale behind the existing practice of applying unsterile adhesives onto a surgical wound.
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Tandon S, Smale M, Pacilli M, Nataraja RM. Tissue adhesive and adhesive tape for pediatric wound closure: A systematic review and meta-analysis. J Pediatr Surg 2021; 56:1020-1029. [PMID: 32888718 DOI: 10.1016/j.jpedsurg.2020.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results. METHODS In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged ≤18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications. RESULTS Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively). CONCLUSIONS TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Matthew Smale
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia; Department of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia; Department of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia.
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Brown JL, Jehle D, Mayrose J, Schwartz L, Pugh J, O'Brien C. Skin tapes and tissue adhesive vs. either method alone for laceration repair in a porcine model. Am J Emerg Med 2020; 45:317-323. [PMID: 33059984 DOI: 10.1016/j.ajem.2020.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE To determine whether the combination of skin tapes and tissue adhesive is superior to either method alone for laceration repair. METHODS This was a prospective, longitudinal experiment on six anesthetized swine. Thirty-six full-thickness linear wounds were created using a metal template, then closed using one of three methods: skin tapes over benzoin, tissue adhesive, or a combination of both. The study was done in two parts. Group 1 (immediate excision) animals were euthanized at day zero for skin excision and tensile strength testing following wound repair. Group 2 (delayed excision) had initial wound repair; animals were euthanized at day 35 for skin excision and tensile strength testing. RESULTS In Group 1, the combination of skin tapes and tissue adhesive provided the strongest immediate wound closure. Average mean force for disruption immediately after wound repair was 19.9 lbs. for the tapes and tissue adhesive group compared to 9.6 lbs. for adhesive alone and 8.9 lbs. for tapes alone. The difference in mean force for combination repair vs. tapes alone was 10.3 lbs. (95% CI 4.1, 16.7), and combination vs. adhesive alone was 10.9 lbs. (95% CI 4.7, 17.3). In Group 2, the mean force required for laceration disruption for those repaired with both tape and tissue adhesive was 188.9 lbs. The mean force until wound disruption for tape only was 165.6 lbs., and the mean force until wound disruption for tissue adhesive alone was 118.9 lbs. The difference in mean force required for wound disruption for those repaired with adhesive alone vs. combination repair is 66.5 lbs. (95% CI 21.2, 111.9). The difference in mean force required for wound disruption between the other two groups was not statistically significant. CONCLUSIONS This study demonstrates that the combination of skin tapes and tissue adhesive provides superior immediate wound closure strength to either of these methods alone in a porcine model.
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Affiliation(s)
- Jennifer L Brown
- Department of Emergency Medicine, State University of New York at Buffalo, Buffalo, NY, United States of America
| | - Dietrich Jehle
- Department of Emergency Medicine, Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, United States of America.
| | - James Mayrose
- Department of Emergency Medicine, State University of New York at Buffalo, Buffalo, NY, United States of America
| | - Lainie Schwartz
- Department of Emergency Medicine, State University of New York at Buffalo, Buffalo, NY, United States of America
| | - Jennifer Pugh
- Department of Emergency Medicine, State University of New York at Buffalo, Buffalo, NY, United States of America
| | - Clay O'Brien
- Department of Emergency Medicine, Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, United States of America
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Kang H. Animal bite injuries and vaccination. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.3.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
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Medel N, Panchal N, Ellis E. Postoperative care of the facial laceration. Craniomaxillofac Trauma Reconstr 2012; 3:189-200. [PMID: 22132257 DOI: 10.1055/s-0030-1268516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations.
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Sellæg MS, Romild U, Kuhry E. Prevention of tape blisters after hip replacement surgery: A randomized clinical trial. Int J Orthop Trauma Nurs 2012. [DOI: 10.1016/j.ijotn.2011.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bacterial growth on adhesive dressing tapes used for the closure of surgical wounds. EUROPEAN JOURNAL OF PLASTIC SURGERY 2006. [DOI: 10.1007/s00238-006-0092-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yavuzer R, Kelly C, Durrani N, Mittal V, Jackson IT, Remine S. Reinforcement of subcuticular continuous suture closure with surgical adhesive strips and gum mastic: Is there any additional strength provided? Am J Surg 2005; 189:315-8. [PMID: 15792758 DOI: 10.1016/j.amjsurg.2005.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 11/19/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to compare the burst strength of suture closure versus the use of suture and strip together. METHODS On cadavers, 50 skin incisions were closed as follows: group 1--subcuticular continuous suture; group 2--same suturing with placement of strips; group 3--same as group 2 except gum mastic was applied prior to strips; group 4--strips alone; and group 5--strips with gum mastic application. The separation forces were measured using a tensilometer. RESULTS The mean separation forces were as follows: group 1, 14.17 kg; group 2, 14.37 kg; group 3, 15.39 kg; group 4, 1.52 kg; and group 5, 3.85 kg. There were no statistically significant differences between groups 1, 2, and 3. When compared with group 4, group 5 required markedly more force to separate the wound. CONCLUSIONS Strip reinforcement with/without gum mastic did not provide any additional strength when sutures were used. Gum mastic increased the adherence of strips and this was important when strips were the only means of wound closure.
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Affiliation(s)
- Reha Yavuzer
- Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
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12
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Abstract
BACKGROUND The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. METHODS Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. RESULTS Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. CONCLUSIONS There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.
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Affiliation(s)
- Jeremy D Kolt
- Sandringham and District Memorial Hospital, Melbourne, Victoria, Australia.
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Abstract
BACKGROUND Surgical adhesive tape strips are often used in the early postoperative period after sutures are removed or are used in place of superficial sutures. There have not been any previous studies demonstrating their optimal application. OBJECTIVE To demonstrate the optimal application pattern for adhesive strips. METHODS Twelve subjects had adhesive strips applied to their forearms in four different patterns and the adherence over time was measured. RESULTS The parallel, nonoverlapping pattern with complete coating of the skin surface with mastisol had the highest degree of adherence. CONCLUSION Failure to coat the entire skin surface with adjunctive adhesive, overlapping of tape strips, and use of tacking strips are all detrimental to strip adherence and should be avoided in clinical practice.
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Affiliation(s)
- K H Katz
- Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Section of Dermatology, Hershey, Pennsylvania, USA
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Roberts PA, Lamacraft G. Techniques to reduce the discomfort of paediatric laceration repair. Med J Aust 1996; 164:32-5. [PMID: 8559093 DOI: 10.5694/j.1326-5377.1996.tb94108.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The wide variety of techniques now available to provide analgesia and sedation in children undergoing laceration repair include needle-free techniques of wound repair, alternative methods of local anaesthetic infiltration, and non-pharmacological interventions. Knowledge and use of these options will help the practitioner limit a child's distress.
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Moy RL, Quan MB. An evaluation of wound closure tapes. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1990; 16:721-3. [PMID: 2394875 DOI: 10.1111/j.1524-4725.1990.tb00110.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Wound closure tapes are often used to decrease tension on wounds, to close wounds, and to reinforce wounds after suture removal. Seven different brands of wound closure tape, both with and without the additional application of the liquid adhesive Mastisol, were tested for their adhesion to the forearms of 8 volunteers when a 225-gram weight was applied. Steri-Strips with Mastisol had the longest time of adhesiveness, and the application of Mastisol markedly increased the adhesiveness of all 7 tapes evaluated. Only 2 of the 7 tapes, Proxi-Strip and Coverstrip II, showed any significant adhesiveness without Mastisol.
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Affiliation(s)
- R L Moy
- Division of Dermatology, University of California, Los Angeles 90024
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Abstract
The purpose of this study was to determine the performance of six different wound closure tapes using a battery of standardized tests that included breaking strength, elongation, air porosity, and shear adhesion. The results of these tests were incorporated into a ranking system that provided an index of the overall performance of each tape. Because Nichi-Strip, Curi-Strip and Steri-Strip wound closure tapes achieved the highest rankings, we recommend their use in the emergency department.
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Affiliation(s)
- G T Rodeheaver
- Department of Plastic Surgery Research, University of Virginia School of Medicine, Charlottesville 22908
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