Sutures vs tissue adhesive
Two papers compared sutures and tissue adhesives. Bozkurt et al had a
high risk of bias, as it did not fully report its cosmetic outcomes,
merely stating “all” patients were satisfied with appearance.
Comparatively, Maw et al is hampered by a lack of randomisation but made
use of blinded assessors and was the only paper to use absorbable
subcuticular sutures, thus providing a potentially more reliable
cosmetic comparison to adhesives. Additionally, this was the only paper
to use a validated wound evaluation scale. The HWES examines five wound
features (rated as yes or no) and an overall wound score from 1-10, and
can be modified to include a patient rating . It has been utilised in
various specialties comparing wound closure methods, ranging from
paediatric surgery to maxillofacial and neurosurgery.
Neither paper found a significant difference in the appearance of scars
between sutures or tissue adhesives. This is echoed in a Cochrane review
which did not find a significant difference in patient or clinician
reported outcomes across 5 studies . However, the authors did report a
higher prevalence of wound dehiscence and a faster closure time in
adhesives, with the latter finding being identified in our review.