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Meta-Analysis
. 2014 Nov 28;2014(11):CD004287.
doi: 10.1002/14651858.CD004287.pub4.

Tissue adhesives for closure of surgical incisions

Jo C Dumville  1 , Paul Coulthard, Helen V Worthington, Philip Riley, Neil Patel, James Darcey, Marco Esposito, Maarten van der Elst, Oscar J F van Waes
Affiliations
Meta-Analysis

Tissue adhesives for closure of surgical incisions

Jo C Dumville et al. Cochrane Database Syst Rev. .

Abstract

Background: Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions.

Objectives: To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds.

Search methods: In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting.

Selection criteria: Only randomised controlled trials were eligible for inclusion.

Data collection and analysis: We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors.

Main results: This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small.

Authors' conclusions: Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

PubMed Disclaimer

Conflict of interest statement

Jo C Dumville: None known Paul Coulthard: was a co‐author in the Blondeel 2004 study. This study was also commercially supported by Ethicon. Philip Riley: None known Helen V Worthington: None known Neil Patel: None known Marco Esposito: None known Maarten van der Elst: None known Oscar J F van Waes: None known James Darcey: None known

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Adhesive versus suture, Outcome 1 Dehiscence: all studies.
1.2
1.2. Analysis
Comparison 1 Adhesive versus suture, Outcome 2 Dehiscence: sensitivity analysis.
1.3
1.3. Analysis
Comparison 1 Adhesive versus suture, Outcome 3 Infection: all studies.
1.4
1.4. Analysis
Comparison 1 Adhesive versus suture, Outcome 4 Infection: sensitivity analysis.
1.5
1.5. Analysis
Comparison 1 Adhesive versus suture, Outcome 5 Cosmetic appearance rated by patient.
1.6
1.6. Analysis
Comparison 1 Adhesive versus suture, Outcome 6 Cosmetic appearance rated by surgeon.
1.7
1.7. Analysis
Comparison 1 Adhesive versus suture, Outcome 7 Patient/parent satisfaction (% satisfied).
1.8
1.8. Analysis
Comparison 1 Adhesive versus suture, Outcome 8 Patient/parent satisfaction (VAS Scale 0 to 100).
1.9
1.9. Analysis
Comparison 1 Adhesive versus suture, Outcome 9 Surgeon satisfaction (% satisfied).
1.10
1.10. Analysis
Comparison 1 Adhesive versus suture, Outcome 10 Time taken for wound closure.
2.1
2.1. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 1 Dehiscence.
2.2
2.2. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 2 Infection.
2.3
2.3. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 3 Cosmetic appearance rated by patient (VAS).
2.4
2.4. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 4 Cosmetic appearance rated by patient (% satisfied).
2.5
2.5. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 5 Cosmetic appearance rated by surgeon (VAS).
2.6
2.6. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 6 Patient satisfaction.
2.7
2.7. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 7 Surgeon satisfaction.
2.8
2.8. Analysis
Comparison 2 Adhesive versus adhesive tape, Outcome 8 Time taken for wound closure.
3.1
3.1. Analysis
Comparison 3 Adhesive versus staples, Outcome 1 Dehiscence.
3.2
3.2. Analysis
Comparison 3 Adhesive versus staples, Outcome 2 Infection.
3.3
3.3. Analysis
Comparison 3 Adhesive versus staples, Outcome 3 Cosmetic appearance rated by patient (scar scale).
3.4
3.4. Analysis
Comparison 3 Adhesive versus staples, Outcome 4 Cosmetic appearance by plastic surgeons (VAS).
3.5
3.5. Analysis
Comparison 3 Adhesive versus staples, Outcome 5 Patient satisfaction.
3.6
3.6. Analysis
Comparison 3 Adhesive versus staples, Outcome 6 Time taken for wound closure.
4.1
4.1. Analysis
Comparison 4 Adhesive versus other method, Outcome 1 Dehiscence.
4.2
4.2. Analysis
Comparison 4 Adhesive versus other method, Outcome 2 Infection.
4.3
4.3. Analysis
Comparison 4 Adhesive versus other method, Outcome 3 Patient satisfaction.
4.4
4.4. Analysis
Comparison 4 Adhesive versus other method, Outcome 4 Clinician satisfaction.
4.5
4.5. Analysis
Comparison 4 Adhesive versus other method, Outcome 5 Time taken for wound closure.
5.1
5.1. Analysis
Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 1 Dehiscence.
5.2
5.2. Analysis
Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 2 Infection.
5.3
5.3. Analysis
Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 3 Patient satisfaction.
5.4
5.4. Analysis
Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 4 Clinician satisfaction.
5.5
5.5. Analysis
Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 5 Time taken for wound closure.
6.1
6.1. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 1 Dehiscence.
6.2
6.2. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 2 Infection.
6.3
6.3. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 3 Cosmetic assessment rated by patient (VAS).
6.4
6.4. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 4 Cosmetic assessment rated by surgeon (VAS).
6.5
6.5. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 5 Surgeon satisfaction (with device).
6.6
6.6. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 6 Surgeon satisfaction (with closure).
6.7
6.7. Analysis
Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 7 Time taken for wound closure.
See this image and copyright information in PMC

Update of

References

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