Tissue adhesives for closure of surgical incisions
Abstract
Background
Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but sutures may induce tissue reactivity and they usually require removal. Tissue adhesives offer the advantages there are no sutures to remove later for the patient and no risk of needlestick injury to the surgeon. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions.
Objectives
To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds.
Search methods
The Cochrane Wounds Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Bibliographies of review articles were checked for studies outside the handsearched journals and wound care product manufacturers were contacted.
Selection criteria
Randomised controlled clinical trials only.
Data collection and analysis
Screening of eligible studies and data extraction was conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors.
Main results
Eight RCTs were included (630 patients). No statistically significant differences were found between various tissue adhesives and sutures (8 trials) for dehiscence, infection, satisfaction with cosmetic appearance when assessed by patients' or surgeons' general satisfaction. Nor were differences found between a tissue adhesive and tapes (2 trials) for infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However a statistically significant difference was found for surgeons' assessment of cosmetic appearance with mean difference 13 (95%CI 5 to 21), the higher mean rating for the tissue adhesive group.
.
Authors' conclusions
Surgeons may consider the use of tissue adhesives as an alternative to sutures or adhesive tape for the closure of incisions in the operating room. There is a need for trials in all areas but in particular to include patients that require incision closure in areas of high tension and patients of general health that may impair wound healing.
PICOs
Plain language summary
Tissue adhesives for closure of surgical incisions
Tissue adhesive maybe quicker and easier to use than stitches for closing surgical wounds, and there are no stitches to remove. This review compares tissue adhesive with stitches and adhesive tape. There were a few studies included and in one study the surgeon rated the cosmetic appearance higher for the incisions closed by the tissue adhesive however no other differences were found. It is unclear whether tissue adhesives are more or less effective for closing surgical incisions than stitches or adhesive tape.
