Traumatic wounds have traditionally been closed with sutures. Recent trials comparing the use of sutures with tissue adhesives have demonstrated similar cosmetic outcomes. To date, all previous studies have compared outcomes between sutures and tissue adhesives at three months after wound closure. Quinn and associates compared traumatic lacerations treated with octylcyanoacrylate, a tissue adhesive recently labeled for this use by the U.S. Food and Drug Administration, with lacerations repaired with sutures.
The one-year study included 135 adult patients with traumatic lacerations requiring repair on the face, torso or extremities. Contaminated wounds, scalp or ear lacerations, and extremity lacerations in patients with diabetes or chronic steroid use constituted exclusion criteria. Wounds requiring debridement or deep suturing were first treated in accordance with the standard practice of the treating physician. Only at the time of skin closure were the lacerations randomized to either closure with monofilament or octylcyanoacrylate tissue adhesive. Patients with wounds requiring no deep care were immediately assigned to one of the two closure techniques. All study physicians were trained in the use of tissue adhesives by the study's lead investigator.
Wound dehiscence was treated by primary closure with the previously randomized method of closure. Follow-up was conducted within 10 days, then at three months and one year after wound repair. All wounds were evaluated at follow-up visits using a previously validated wound-evaluation scale. Photographs taken by a research assistant at three months and one year were rated for cosmesis by a cosmetic surgeon. Of the 77 patients who were available at the three-month and the one-year follow-up visits, there was no difference in primary outcome, visual analog cosmesis score or percentage of optimal wounds score between the two treatment groups.
The authors conclude that there is no difference one year after treatment in the cosmetic outcomes of wounds repaired with tissue adhesives and those closed with sutures. Their findings confirmed earlier similarities in cosmetic results noted after three months. Physicians who use octylcyanoacrylate should know its proper indications and method of application (see the accompanying table). Topical anesthetics help to achieve hemostasis, permit proper cleansing and allow a needle-less closure. Tissue adhesives should always be applied topically, never between the wound edges.
editor's note: Cyanoacrylate tissue adhesives have demonstrated satisfactory wound healing and cosmetic results, while requiring less time to initially close a wound than suturing. Subjective parental reporting of perceived pain among children undergoing wound closure is significantly less with the chemical tissue adhesive. Application of the adhesive can be difficult because the low viscosity of the formulas causes “running” of the adhesive on initial application. This “running” can be diminished by using a needle placed in the top of the tube or by releasing the adhesive down a needle to provide more exact application. Future formulas will be more “user friendly.”—r.s.