Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis

Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture in closure of linear wounds of the trunk and extremities: A randomized evaluator-blinded split-wound comparative effectiveness trial

BACKGROUND

Both running horizontal mattress (HM) and running subcuticular (SQ) suturing techniques have been suggested to be superior to other running cuticular suturing techniques. These 2 techniques have not been directly compared.

OBJECTIVE

To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects.

METHODS

Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. One side of the surgical wound was randomized to receive one intervention (HM vs SQ) with the other side receiving the alternate intervention. The primary outcome was the Patient and Observer Scar Assessment Scale (POSAS) score at a minimum of 3 months postoperatively.

RESULTS

Observer POSAS sum of components was 19.49 and 17.76 for HM and SQ, respectively (P = .14). The mean score for patient overall opinion was 4.71 for HM and 3.50 for the SQ technique (P = .02). Overall opinion scores of evaluators were 3.87 and 3.29 for HM and SQ, respectively (P = .03).

LIMITATIONS

Single-center study of a relatively homogenous population.

CONCLUSION

Although there was no significant difference in the sum of POSAS components between HM and SQ (P = .14), both patients and evaluators had a superior overall opinion of the SQ-treated side (patient P = .02, evaluator P = .03).

Fast absorbing gut sutures in dermatologic surgery: a systematic review and meta-analysis

INTRODUCTION

Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities.

METHODS

A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates.

RESULTS

Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01).

CONCLUSION

If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.

Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial

BACKGROUND

Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome.

OBJECTIVE

Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques.

METHODS

This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]).

RESULTS

The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18).

CONCLUSION

No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.

Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial

BACKGROUND

Dermatologic surgeons are increasingly using surgical adhesives in their practice. Studies comparing sutured wounds to those that utilize a combination of suturing and skin adhesive have not been previously conducted.

OBJECTIVE

To compare the cosmetic outcome and patient wound care satisfaction of an intermediate suture closure with an intermediate suture closure followed by the application of 2-octyl cyanoacrylate (2-OCA).

METHODS

Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. Following intermediate sutured closure of a surgical defect, one side of the wound was randomized to receive an additional application of 2-OCA. After 3 months, the scar was assessed using the POSAS tool and patients reported wound care preferences.

RESULTS

As the primary outcome measure, the mean sum of observer POSAS was 12.80 for sutured closure alone versus 12.40 for sutured closures followed by 2-OCA (P = .49).

LIMITATIONS

Single-center study of a relatively homogenous population.

CONCLUSION

Although there were no significant differences in scar cosmesis, both patients and observers tended to prefer the side with an additional application of 2-OCA in most POSAS components, in overall opinion, and in patient wound care satisfaction. Dermatologic surgeons may add this to their practice without sacrificing scar outcomes or patient satisfaction.

Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative effectiveness trial

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.

Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859.

Prolonged Usage of an Adhesive Wound Closure Device in Postoperative Facial Scar Management: A Split-Wound Randomized Controlled Trial

Background: Additional skin support is promising in scar management, especially for wounds under high tension. Options for effective skin support are limited. This study aimed to determine whether prolonged use of an adhesive wound closure (AWC) device prevents scar spread and improves final appearance. Patients and Methods: This is a split-wound randomized evaluator-blinded study of 14 patients with facial wounds under high tension. After surgical closure, one half of each wound was randomly allocated to receive either standard care or additional 3-month treatment with an AWC device. Scar width, scar scale, and side effects were evaluated 12 months after surgery. Results: A significant difference was observed in scar width between the treated and nontreated sites at 12-month, with a mean difference of 1.024 (95% confidence interval, 0.347-1.700) mm in favor of the treated group. Scar widths in both groups increased rapidly in the first month after surgery and gradually increased until the sixth month. Scale for vascularization and relief were significantly lower in the treated sites. No significant differences were found in complications between two groups. Conclusions and Relevance: Prolonged usage of the AWC device prevented scar spread at 12 months and improved final scar scores in vascularization and relief. Clinical Trial Registration number: ChiCTR1900027155.