Comparative Aesthetic Outcomes of Wound Closure Methods Following Thyroidectomy: A Systematic Review and Meta-Analysis

Abstract

Background: Thyroidectomy is among the most common surgical procedures worldwide. Despite advancements in surgical techniques, cosmetic outcomes following thyroidectomy continue to be a major concern. One of the key factors that could influence postoperative results is the method of wound closure; however, there is no established consensus on the optimal wound closure approach. Our study aims to compare the cosmetic outcomes of the available wound closure methods in patients undergoing thyroidectomy.

Methods: We conducted an extensive search across four databases until February 2025. We included all studies that evaluate the cosmetic outcomes of various wound closure methods after thyroidectomy. Our primary outcomes were the Patient and Observer Scar Assessment Scales (POSAS), operative time required for wound closure, and the ability to shower. Continuous outcomes were analyzed as mean differences (MD) with their 95% confidence intervals (CI), while dichotomous variables were pooled as risk ratios (RR) with 95% CI.

Results: Our review included twelve randomized controlled trials and three observational cohort studies involving 1131 patients who underwent thyroidectomy. The pooled analysis revealed higher OSAS in the tissue adhesive group compared to the subcuticular suture group (MD=4.50, 95% CI [1.83 to 7.16], p=0.001). However, there was no significant difference between the two approaches regarding PSAS scores (MD=4.16, 95% CI [ -4.18 to 12.51], p=0.33). Additionally, tissue adhesives were linked to a shorter wound closure time compared to subcuticular sutures (MD= -3.33, 95% CI [ -5.88 to -0.78], p=0.01). When compared to staples, tissue adhesives exhibited higher rates of excellent ability to shower (RR=5.66, 95% CI [1.87 to 17.13], p=0.001).

Conclusion: Tissue adhesive is associated with poorer scar appearance but faster wound closure when compared to subcuticular sutures. Moreover, tissue adhesive also showed a better ability to shower compared to staples.

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Keywords: Closure; Scar; Thyroidectomy; Wound.