A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions

Abstract

Objective: To compare the tissue adhesive octylcyanoacrylate with subcuticular suture for the closure of head and neck incisions.

Design: A prospective comparison with a blinded assessment of cosmetic outcome.

Subjects: Fifty consecutive patients undergoing head and neck procedures at two University of Ottawa teaching hospitals.

Methods: Twenty-six patients underwent skin closure with monofilament suture and 24 were closed with tissue adhesive. At 4 to 6 weeks the incisions were evaluated with a validated wound scale. Photographs of the incisions were rated using a visual analogue scale by two facial-plastic otolaryngologists who were blinded to the method of skin closure.

Results: The adhesive provided faster skin closure (29.7 seconds vs 289.0 seconds, p < .0001), and there were no differences in complications between the two groups. The primary outcome measure was the cosmetic appearance of the incision at 4 to 6 weeks. Although the adhesive group scored higher on both cosmesis scales, the visual analogue scale (octylcyanoacrylate 58.7 mm vs suture 53.2 mm) and the wound evaluation scale (57% vs 50% optimal wound scores), there were no statistical or clinically significant differences on either scale. The two facial-plastic otolaryngologists had good intraobserver and interobserver agreement when rating the cosmetic outcomes (0.87 and 0.71 respectively).

Conclusions: Octylcyanoacrylate was found to be an effective method of skin closure in clean head and neck incisions. The practical advantages of tissue adhesives are reviewed.