Skin Adhesive vs Skin Sutures for Wound Closure in Hernia Repair: A Randomized Controlled Trial

Authors

  • Ammara Salam Fazaia Ruth Pfau Medical College, Karachi, Pakistan
  • Maria Ahmed Dow University of Health Sciences, Civil Hospital Karachi, Pakistan
  • Summaya Saeed Dow University of Health Sciences, Civil Hospital Karachi, Pakistan
  • Aun Ali Khowaja Fazaia Ruth Pfau Medical College, Karachi, Pakistan
  • Amjad Siraj Memon Principal Dow Medical College, Dow University of Health Sciences, Civil Hospital Karachi, Pakistan

DOI:

https://doi.org/10.12970/2310-998X.2019.07.02

Keywords:

 Wound closure, Skin adhesive, Skin sutures, Hernia mesh repair incisions.

Abstract

Background: Wound closure is an important step in all sorts of surgeries, whether elective or emergency. Wound closure techniques vary from conventional skin suturing to natural glues, skin staples, and tapes. A good wound closure is one that ensures optimal healing. There are several aspects of wound closure technique that can render it either good or bad. This study is designed to investigate the outcomes of skin adhesives. The technique which leads to a better outcome is recommended moving forward so that we can reduce associated complications and costs in terms of post-surgical infection.

Methods: A randomized controlled trial was conducted in Surgical Unit-3, Civil Hospital Karachi from 9th Feb 2018 to 8th Aug 2018. A total of 130 patients undergoing open inguinal hernia mesh repair (i.e., hernioplasty) were randomly allocated to two groups. Patients in Group A were treated with skin adhesive, patients in and Group B were treated with subcuticular sutures. All patients were operated on in the usual manner using Lichtenstein’s technique, and mesh was applied. In the post-operative period, all patients were observed for signs of wound infection according to the Southampton Score. Scar cosmesis was calculated using the Hollander Score at six weeks.

Results: The average age of the patients was 45.42±8.70 years. There were 105(80.8%) males and 25(19.2%) females. The rate of wound infection and dehiscence was not statistically significant between both groups. The mean application time of skin closure was significantly lower in Group A than Group B.

Conclusion: From this study, it can be concluded that the use of tissue adhesives has an advantage of saving time when compared to conventional suturing.

References

Quinn JV, Drzewiecki A, Li MM, StiellIG, Sutcliffe T, Elmslie TJ, Wood WE. A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Annals of Emergency Medicine 1993; 22(7): 1130-5. https://doi.org/10.1016/S0196-0644(05)80977-1

Bruns TB, Simon HK, McLario DJ, Sullivan KM, Wood RJ, Anand KJ. Laceration repair using a tissue adhesive in a children's emergency department. Pediatrics 1996; 98(4): 673-5.

Wells GA, Ducic Y, Ode PF. A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions. Journal of Otalaryngotagy 1997; 26(1): 26-30.

Quinn JV. Tissue Adhesives in Wound Care. Hamilton, Ont. BC Decker. Inc. Electronic book 1998.

Toriumi DM, Raslan WF, Friedman M, Tardy ME. Histotoxicity of cyanoacrylate tissue adhesives: a comparative study. Archives of Otolaryngology–Head & Neck Surgery 1990; 116(5): 546-50. https://doi.org/10.1001/archotol.1990.01870050046004

Toriumi DM, Raslan WF, Friedman M, Tardy Jr ME. Variable histotoxicity of histoacryl when used in a subcutaneous site: an experimental study. The Laryngoscope 1991; 101(4): 339-43. https://doi.org/10.1002/lary.1991.101.4.339

Jallali N, Haji A, Watson CJ. A prospective randomized trial comparing 2-octyl cyanoacrylate to conventional suturing in closure of laparoscopic cholecystectomy incisions. Journal of Laparoendoscopic& Advanced Surgical Techniques 2004; 14(4): 209-11. https://doi.org/10.1089/lap.2004.14.209

Soni A, Narula R, Kumar A, Parmar M, Sahore M, Chandel M. Comparing cyanoacrylate tissue adhesive and conventional subcuticular skin sutures for maxillofacial incisions—a prospective randomized trial considering closure time, wound morbidity, and cosmetic outcome. Journal of Oral and Maxillofacial Surgery 2013; 71(12): 2152-e1. https://doi.org/10.1016/j.joms.2013.08.029

Wells GA, Ducic Y, Ode PF. A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions. Journal of Otalaryngotagy 1997; 26(1): 26-30.

Gennari R, Rotmensz N, Ballardini B, Scevola S, Perego E, Zanini V, Costa A. A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery. Surgery 2004; 136(3): 593-9. https://doi.org/10.1016/j.surg.2004.02.015

Switzer EF, Dinsmore RC, North JrJH. Subcuticular closure versus Dermabond: a prospective randomized trial. The American Surgeon 2003; 69(5): 434.

Al-Mubarak L, Al-Haddab M. Cutaneous wound closure materials: an overview and update. Journal of Cutaneous and Aesthetic Surgery 2013; 6(4): 178. https://doi.org/10.4103/0974-2077.123395

Bookland MJ, Sukul V, Connolly PJ. Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates. Journal of Neurosurgery 2014; 121(1): 189-94. https://doi.org/10.3171/2013.12.JNS13700

Grimaldi L, Cuomo R, Brandi C, Botteri G, Nisi G, D'aniello CA. Octyl-2-cyanoacrylate adhesive for skin closure: eight years experience. In Vivo 2015; 29(1): 145-8.

The Cochrane Collaboration. Tissue adhesives for closure of surgical incisions. London: John Wiley & Sons, Ltd. 2014.

Osmond MH. Pediatric wound management: the role of tissue adhesives. Pediatric Emergency Care 1999; 15(2): 137-40. https://doi.org/10.1097/00006565-199904000-00015

Fitzgibbons Jr RJ, Forse RA. Groin hernias in adults. New England Journal of Medicine 2015; 372(8): 756-63. https://doi.org/10.1056/NEJMcp1404068

“Inguinal hernia” Mayo Clinic 2017-08-11.

Sebesta MJ, Bishoff JT. Octylcyanoacrylate skin closure in laparoscopy. Journal of Endourology 2003; 17(10): 899-903. https://doi.org/10.1089/089277903772036235

Sniezek PJ, Walling HW, Debloom III JR, Messingham MJ, Vanbeek MJ, Kreiter CD, Whitaker DC, Arpey CJ. A randomized controlled trial of high‐viscosity 2‐octyl cyanoacrylate tissue adhesive versus sutures in repairing facial wounds following Mohs micrographic surgery. Dermatologic Surgery 2007; 33(8): 966-71. https://doi.org/10.1097/00042728-200708000-00010

Maartense S, Bemelman WA, Dunker MS, De Lint C, Pierik EG, Busch OR, Gouma DJ. Randomized study of the effectiveness of closing laparoscopic trocar wounds with octylcyanoacrylate, adhesive papertape or poliglecaprone. British Journal of Surgery 2002; 89(11): 1370-5. https://doi.org/10.1046/j.1365-2168.2002.02235.x

Souza EC, Fitaroni RB, Januzelli DM, Macruz HM, Camacho JC, Souza MR. Use of 2-octyl cyanoacrylate for skin closure of sternal incisions in cardiac surgery: observations of microbial barrier effects. Current Medical Research and Opinion 2008; 24(1): 151-5. https://doi.org/10.1185/030079908X253807

Yang YL, Xiang YY, Jin LP, Pan YF, Zhou SM, Zhang XH, Qu JM. Closure of skin incision after thyroidectomy through a supraclavicular approach: a comparison between tissue adhesive and staples. Scandinavian Journal of Surgery 2013; 102(4): 234-40. https://doi.org/10.1177/1457496913490610

Van den Ende ED, Vriens PW, Allema JH, Breslau PJ. Adhesive bonds or percutaneous absorbable suture for closure of surgical wounds in children. Results of a prospective randomized trial. Journal of Pediatric Surgery 2004; 39(8): 1249-51. https://doi.org/10.1016/j.jpedsurg.2004.04.013

Coulthard P, Esposito M, Worthington HV, van der Elst M, van Waes OJ, Darcey J. Tissue adhesives for closure of surgical incisions. Cochrane Database of Systematic Reviews 2002; (3). https://doi.org/10.1002/14651858.CD004287.pub2

Matin SF. Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. Journal of the American College of Surgeons 2003; 196(6): 845-53. https://doi.org/10.1016/S1072-7515(03)00119-4

Maniar N, Deshpande A. A randomized controlled trial of tissue adhesive versus sutures in the closure of port-site incisions in laparoscopic surgery. IOSR J Dent Med Sci 2016; 15(8): 66-70. https://doi.org/10.9790/0853-1508056670

Downloads

Published

2019-03-25

Issue

Section

Articles