Tissue adhesives for traumatic lacerations in children and adults

Abstract

Background: Tissue adhesives have been used for many years to close simple lacerations as an alternative to standard wound closure (sutures, staples, adhesive strips). Potential advantages over standard wound closure include ease of use, decrease in pain, time to apply and not requiring a follow-up visit for removal. Whilst studies have compared tissue adhesives with standard wound closure to determine the cosmetic outcome and other secondary outcomes no systematic review was previously available, so that no generalizable, definitive answers about the effectiveness of tissue adhesives existed. Objectives: To summarize the best available evidence for the effects of tissue adhesives on the healing of traumatic lacerations in children and adults. Search methods: We searched the Cochrane Wounds Group Specialised Trials Register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2007), MEDLINE (1950 to October Week 1 2007), EMBASE (1980 to 2007 Week 41), CINAHL (1982 to October Week 2 2007), Web of Science - Science Citation Index (1975 to April 29, 2007), seven clinical trial registries, and reference lists of articles. We also contacted manufacturers and researchers in the field. Selection criteria: Randomised controlled trials comparing tissue adhesives with standard wound closure or one tissue adhesive compared with another tissue adhesive for acute, linear, low tension, traumatic lacerations in an emergency or primary care setting. Data collection and analysis: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Information on adverse effects was collected from the trials. Outcomes of cosmesis (subgroups of age, wound location and need for deep sutures), pain, procedure time, ease of use, and complications were analysed separately for two comparisons: 1) tissue adhesive compared with standard wound closure; and 2) tissue adhesive compared with another tissue adhesive. Main results: Thirteen studies were included in this review. Eleven studies compared a tissue adhesive with standard wound closure. No significant difference was found for cosmesis at any time point examined, using either Cosmetic Visual Analogue Scale (CVAS) or Wound Evaluation Score (WES). Pain scores (Parent VAS weighted mean difference (WMD) -13.4 mm; 95% CI -20.0 to -6.9) and procedure time (WMD -4.7 minutes; 95% CI -7.2 to -2.1) significantly favoured tissue adhesives. Only one study reported on ease of use, favouring standard wound closure. Small but statistically significant risk differences were found for dehiscence (favouring standard wound care, Number Needed to Harm (NNH) 40; 95% CI 20 to 1168) and erythema (favouring tissue adhesive, NNH 10; 95% CI 5 to 239). Other complications were not significantly different between treatment groups. Two studies compared tissue adhesives. One study compared two different tissue adhesives, butylcyanoacrylate with octylcyanoacrylate, for pediatric facial lacerations and found no significant difference for cosmesis, pain, procedure time, or complications. Another study compared two different formulations (viscosities) of octylcyanoacrylate to assess the incidence of product migration as a proxy for complications of application; the high-viscosity product migrated on significantly fewer participants. Authors' conclusions: Tissue adhesives are an acceptable alternative to standard wound closure for repairing simple traumatic lacerations. They offer the benefit of decreased procedure time and less pain, when compared to standard wound closure. A small but statistically significant increased rate of dehiscence with tissue adhesives is observed.