Tissue Adhesive Compared With Sterile Strips After Cesarean Delivery: A Randomized Controlled Trial

Tissue Adhesive versus Skin Suture plus Waterproof Wound Dressings for Carpal Tunnel Wound Closure: A Prospective Randomized Controlled Trial

Introduction

The popular wound closure methods for carpal tunnel decompression (CTD) include non-absorbable and absorbable sutures which have comparable results in clinical outcomes. However, these wound closure methods are recommended to keep a wound dry which may limit some ADLs. We conducted a prospective randomized controlled trial that compares clinical outcomes and cost-effectiveness in a skin closure following CTD between absorbable sutures plus a 2-octyl cyanoacrylate tissue adhesive (2OCA) versus non-absorbable skin sutures plus a waterproof dressing (NSPWD).

Materials and Methods

We enrolled 120 patients undergoing CTD into two groups: 2OCA and NSPWD, with 60 patients in each group. Number of dressing changes, Quick DASH, pain VAS, cosmetic VAS, patient satisfaction VAS, and Hollander wound evaluation score, cost-effectiveness, and post-operative complications were collected at pre-operative period and two and six weeks post-operatively.

Results

Slightly better patient satisfaction VAS (7.9 vs 7.2, p=0.018) and cosmetic VAS (8.0 vs 7.2, p=0.025) were observed in 2OCA at 2 weeks. Meanwhile, NSPWD revealed lesser times of dressing change (Median, mode, IQR: 0/0/0 vs 2/3/2, p<0.001). The total wound-related costs include dressing change and suture removal cost ($15.9 for 2OCA vs $19.2 for NSPWD, p=0.002) although an initial wound-related cost in 2OCA was higher ($15.7/case vs $7.9/case, p<0.001).

Conclusion

Our study revealed that the supplementary tissue adhesive to absorbable sutures following CTD could reduce total wound-related costs while clinical outcomes might not be considered clinically significant.

Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea

Purpose

This study was performed to evaluate the safety and feasibility of skin adhesives and to compare postoperative and cosmetic outcomes after wound closure in single-port laparoscopic appendectomy (SPLA) between skin adhesives and steri-strips.

Methods

This was a single-center retrospective study. We included 22 and 47 patients in whom skin adhesive and steri-strips were used respectively, for skin closure after subcuticular suturing in SPLA between August 2014 and 2020. The patient scar assessment questionnaire (PSAQ) was completed postoperatively to assess postoperative cosmetic outcomes.

Results

On the postoperative day, patients in whom skin adhesive was used had significantly lower numeric rating scores than in whom steri-strips were used (2.8 ± 0.8 vs. 3.9 ± 0.8, p < 0.001). The frequency of analgesic administration within 24 hours and between 24 and 48 hours after surgery was significantly lower in the skin adhesive group compared to the wound closure strip group (1.4 ± 0.8 vs. 2.7 ± 1.2, p = 0.013 and 0.2 ± 0.4 vs. 0.7 ± 0.9, p = 0.002, respectively). In the PSAQ, "satisfaction with appearance" and "satisfaction with symptoms" subitem scores were significantly lower in patients in whom skin adhesive was used (11.3 ± 3.0 vs. 15.1 ± 4.5, p = 0.006 and 6.5 ± 1.8 vs. 9.5 ± 3.3, p = 0.003), whereas, "appearance" and "consciousness" subitems revealed no statistically significant differences between the groups.

Conclusion

Liquid skin adhesive closures seem to be safe and feasible and cause less postoperative pain, resulting in greater patient satisfaction with postoperative scars than wound closure strip closure after subcuticular suturing in SPLA.

Number and quality of randomized controlled trials in obstetrics published in the top general medical and obstetrics and gynecology journals

BACKGROUND

There has been an increasing number of randomized controlled trials published in obstetrics and maternal-fetal medicine to reduce biases of treatment effect and to provide insights on the cause-effect of the relationship between treatment and outcomes.

OBJECTIVE

This study aimed to identify obstetrical randomized controlled trials published in top weekly general medical journals and monthly obstetrics and gynecology journals, to assess their quality in reporting and identify factors associated with publication in different journals.

STUDY DESIGN

The 4 weekly medical journals with the highest 2019 impact factor (New England Journal of Medicine, The Lancet, The Journal of the American Medical Association, and British Medical Journal), the top 4 monthly obstetrics and gynecology journals with obstetrics-related research (American Journal of Obstetrics & Gynecology, Ultrasound in Obstetrics & Gynecology, Obstetrics & Gynecology, and the British Journal of Obstetrics and Gynaecology), and the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine were searched for obstetrical randomized controlled trials in the years 2018 to 2020. The primary outcome was the number of obstetrical randomized controlled trials published in the obstetrics and gynecology journals vs the weekly medical journals and the percentage of trials published, overall and per journal. The secondary outcomes included the proportion of positive vs negative trials overall and per journal and the assessment of the study characteristics of published trials, including quality assessment criteria.

RESULTS

Of the 4024 original research articles published in the 9 journals during the 3-year study period, 1221 (30.3%) were randomized controlled trials, with 137 (11.2%) randomized controlled trials being in obstetrics (46 in 2018, 47 in 2019, and 44 studies in 2020). Furthermore, 33 (24.1%) were published in weekly medical journals, and 104 (75.9%) were published in obstetrics and gynecology journals. The percentage of obstetrical randomized controlled trials published ranged from 1.5% to 9.6% per journal. Overall, 34.3% of obstetrical trials were statistically significant or "positive" for the primary outcome. Notably, 24.8% of the trials were retrospectively registered after the enrollment of the first study patient. Trials published in the 4 weekly medical journals enrolled significantly more patients (1801 vs 180; P<.001), received more often funding from the federal government (78.8% vs 35.6%; P<.001), and were more likely to be multicenter (90.9% vs 42.3%; P<.001), non-United States based (69.7% vs 49.0%; P=.03), and double blinded (45.5% vs 18.3%; P=.003) than trials published in the obstetrics and gynecology journals. There was no difference in study type (noninferiority vs superiority) and trial quality characteristics, including pretrial registration, ethics approval statement, informed consent statement, and adherence to the Consolidated Standards of Reporting Trials guidelines statement between studies published in weekly medical journals and studies published in obstetrics and gynecology journals.

CONCLUSION

Approximately 45 trials in obstetrics are being published every year in the highest impact journals, with one-fourth being in the weekly medical journals and the remainder in the obstetrics and gynecology journals. Only about a third of published obstetrical trials are positive. Trials published in weekly medical journals are larger, more likely to be funded by the government, multicenter, international, and double blinded. Quality metrics are similar between weekly medical journals and obstetrics and gynecology journals.

The Application of Tissue Glue in Eyelid Laceration Repair in Children During the Coronavirus Disease 2019 Pandemic Lockdown in Wuhan

OBJECTIVE

To discuss a rapid and effective treatment used for children with eyelid lacerations during the COVID-19 lockdown in Wuhan to limit the risk of cross-infection.

METHODS

A comparative study was conducted of forty-five patients with eyelid lacerations who attended the Ophthalmology Department of Wuhan Children's Hospital between January 23, 2020 and March 6, 2020. The tissue glue Histoacryl was used to bond the wounds in 24 cases, while the traditional suture method was used for 21 cases. The wound healing time, complications, treatment satisfaction, and number of visits of the two groups were compared.

RESULTS

The two groups had similar baseline characteristics. The wound healing time (from wound disinfection to wound dressing) was shorter in the tissue glue group (4.35 ± 0.47min versus 11.71 ± 1.85 min, P< 0.01). There was 1 case of wound dehiscence in the tissue glue group. Twenty-two cases in the tissue glue group were satisfied, 2 cases were basically satisfied, and 0 were dissatisfied. Eleven cases in the traditional suture group were satisfied, 9 cases were basically satisfied, and 1 case was dissatisfied. The difference was statistically significant (P < 0.05). In terms of the number of visits, the tissue glue group visited (1.54 ± 0.88) times, while the traditional suture group visited (2.38 ± 0.59) times. The difference between the two groups was statistically significant (P < 0.01). The real-time reverse transcriptase polymerase chain tests for severe acute respiratory syndrome coronavirus 2 of all medical staff in the ophthalmology emergency room were negative.

CONCLUSION

Compared with the traditional suture method, tissue glue used in eyelid laceration in children has the advantages of painlessness, shorter operation duration, higher safety and satisfaction, greater ease of care, and fewer hospital visits. Tissue glue can be widely used to reduce the risk of cross-infection.

Tissue adhesive for wound closure in enhanced-recovery total hip arthroplasty: a prospective, randomized and controlled study

Background

We aimed to present our experience of adopting tissue adhesive as adjunct to standard wound closure in total hip arthroplasty (THA) and evaluate its performance.

Methods

From September 2019 to November 2019, we prospectively enrolled consecutive patients who underwent simultaneous bilateral THA in this randomized and controlled study. Standard wound closure was applied on one side of hip while additional tissue adhesive was applied on the other side at random. We collected and analyzed patients’ information, including age, gender, body mass index (BMI), diagnosis, postoperative length of stay (LOS), dressing changes, wound evaluation scores, wound-related cost and complications.

Results

Thirty patients with simultaneous bilateral THA were enrolled in this study. During the hospital stay, the times of dressing change in hips with tissue adhesive was significantly less than that in the other hips (p = 0.000). However, the wound-related cost in hips with tissue adhesive was significantly higher (p = 0.000). According to patients’ feedback at one-month follow-up, wound evaluation of hips with tissue adhesive was significantly better than the other hips (p = 0.004). Seventeen patients preferred tissue adhesive and only five patients preferred standard wound closure.

Conclusions

Tissue adhesive could significantly reduce wound drainage and increase patients’ satisfaction, which can be an ideal adjunct to standard wound closure in enhanced-recovery THA.

Trial registration

Chinese Clinical Trial Registry; ChiCTR1900025730; Registered 6 September 2019.