Effect of Adhesive Strips and Dermal Sutures Versus Dermal Sutures Only on Wound Closure: A Randomized Clinical Trial

May Le, Mercer University College of Pharmacy 2015

According to the United States Department of Labor, cuts, lacerations, and punctures are the third most common cause of nonfatal occupational injuries and illnesses.1  Reported skin closure materials for these wounds include tissue adhesives, adhesive tapes, sutures, and staples. When surgeons select which materials to use, they are suggested to consider factors such as the type and location of the wound, available skin closure materials, and patient condition. It is stated that sutures are frequently used in surgery and that absorbable sutures are mainly used as buried sutures to help close the dermis and subcutaneous tissue.  Adhesive tapes are reported to be commonly used after suture removal for adjunctive wound support, in conjunction with buried dermal sutures, and with subcuticular sutures.

A recently published study compared the use of adhesive strips and dermal sutures versus dermal sutures only in wound closure.3

Title:  Effect of Adhesive Strips and Dermal Sutures vs Dermal Sutures Only on Wound Closure: :  A Randomized Clinical Trial3
Design Prospective, single-center, randomized; N= 48
Objective To determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure
Study Groups The study group consisted of 48 patients. For each patient, half of the wound was treated with buried interrupted subcuticular sutures with overlying adhesive strips and the other half of the wound was treated with buried interrupted subcuticular sutures alone.
Methods Randomization for the sides of the wound was performed.  The wound side assigned to adhesive strips was coated with a supplemental adhesive.  After it was dried, adhesive strips were then applied.  Patients were instructed to follow-up with wound care for one week. Two observers blinded to the study and the patient evaluated the wound using the Patient Observer Scar Assessment Scale (POSAS), which consists of six components scored on a one to ten scale (one= best; ten= worst).  The scores were summed up with six as the best score and 60 as the worst.
Duration November 14, 2013 to May 16, 2014
Primary Outcome Measure The POSAS scores for wound vascularity, pigmentation, thickness, relief, pliability, and surface area components given by observers at three-months follow up

The POSAS scores for wound pain, itching, color, stiffness, thickness, and irregularity given by patients at three-months follow up

Baseline Characteristics Mean age 63.5 years, male 69%, white 96%, Pacific Islander 2%, other 2%, training level of surgeon (attending 29%, Mohs fellow 38%, resident 33%), location of surgical procedure (preauricular 2%, neck 10%, arm 13%, back 8%, chest 13%, abdomen 2%, scalp 4%, forehead 21%, cheek 27%)
Results Adhesive strips versus no adhesive strips:

Observer POSAS score: vascularity 2.6% vs 2.7% (p= 0.59), pigmentation 1.3% vs 1.4% (p= 0.40), thickness 2% vs 2.2% (p= 0.26), relief 2.1% vs 2% (p= 0.6), pliability 2.2% vs 2.3% (p= 0.22), surface area 2.1% vs 2.3% (p= 0.18), sum of components 12.3% vs 12.9% (p= 0.32)

Patient POSAS score: pain 1.1% vs 1.3% (p= 0.23), itching 1.6% vs 1.5% (p= 0.41), color 3.4% vs 3.6% (p= 0.28), stiffness 2.7% vs 2.9% (p= 0.46), thickness 1.9% vs 2% (p= 0.49), irregularity 3.3% vs 3.4% (p= 0.87), sum of components 14% vs 14.7% (p= 0.39)

Adverse Events Common Adverse Events: not reported
Serious Adverse Events: adhesive vs non-adhesive (dehiscence one vs two, suture abscess three vs six, splitting suture zero vs one)
Percentage that Discontinued due to Adverse Events: not reported
Study Author Conclusions Combination closure with adhesive strips and buried interrupted subcuticular suturing was not significantly associated with improved overall scar assessment compared with buried interrupted subcuticular suturing alone when evaluated by blinded observers or the patients themselves. Our results do not support the use of adhesive strips as a means to improve cosmetic outcomes or reduce scar width.

There was no cosmetic scar improvement with the addition of adhesive strips to buried subcuticular sutures.  There was no significant difference in adverse events between the dermal sutures only procedure and the dermal sutures plus adhesive strips procedure.  Since the primary outcomes were based on observation, the results may be subjective.  Based on this study, surgeons may save time by not adding adhesive strips to sutures.  Further studies with a larger sample size are needed to confirm the finding.3

References:

  1. United States Department of Labor. Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work.  2013. Available at: http://www.bls.gov/news.release/pdf/osh2.pdf.  Accessed April 18, 2015.
  1. Al-mubarak L, Al-haddab M. Cutaneous wound closure materials: an overview and update. J Cutan Aesthet Surg. 2013;6(4):178-88.
  1. Custis T, Armstrong AW, King TH, Sharon VR, Eisen DB. Effect of Adhesive Strips and Dermal Sutures vs Dermal Sutures Only on Wound Closure: A Randomized Clinical Trial. JAMA Dermatol. 2015.
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