Primary outcome measure
Four out of five papers comparing sutures and staples noted no
significant difference in wound cosmesis, with one (Oswal) finding a
significantly superior cosmetic outcome favouring staples at 3 months
(p=0.03). No studies found a significant difference in cosmetic outcomes
between sutures or tissue adhesives. Three papers compared cosmetic
outcomes using a visual analogue scale only one using a validated
assessment tool, the Hollander wound evaluation score (HWES). A
“good”, “moderate” and “poor” observer assessment scale was used
in 3 papers. Six studies used independent observers, of which 4 reported
blinding of these assessors. Only Bozkurt used a patient orientated
assessment, using a “yes/ no” question for satisfaction with
appearance. Timing of follow-up assessments varied wildly, from date of
removal to 180 days. A summary of cosmetic outcomes is given intable 3 .