#366 Looking for Closure: Managing simple excisions or wounds efficiently
CLINICAL QUESTION
What are some options for efficiency in wound closure?
BOTTOM LINE
Punch biopsies 4mm do not require closure but 8mm do. Skin-glue is similar to tape or sutures for simple wounds for clinician-rated cosmesis and patient satisfaction with similar infection rates of 4-7%. However, dehiscence occurs in ~5% with skin-glue compared to 1% with suture. Absorbable sutures have similar outcomes to non-absorbable sutures.
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EVIDENCE
- Results statistically significant unless otherwise stated.
- Punch biopsy: One randomized controlled trial (RCT), 77 patients, two 4- or 8-mm punch biopsies on arm/leg/trunk, one sutured and other closed by secondary-intention. Assessed at 9 months.1
- Clinician-rated comesis: No difference.
- Patient preference:
- 4mm: No difference.
- 8mm: 14% preferred secondary-intention versus 53% preferred suture (remainder: no preference).
- Skin-glue (adhesive) versus sutures: One systematic review (33 RCTs, 2793 lacerations) of incisional wounds:2
- Wound dehiscence (17 RCTs, 1225 patients): 4.5% skin-glue versus 1.3% sutures
- Time to closure (5 RCTs, 407 patients): Not pooled, results inconsistent.
- Clinician/patient satisfaction, infection: No difference.
- Second systematic review3 included non-randomized studies: No difference in wound cosmesis.
- Skin-glue versus tape: Two systematic reviews (16-33 RCTs, 2793-9783 lacerations), children/adults with lacerations/incisions:2,3
- Clinician-rated cosmesis (3 RCTs, 173 wounds):3 Standard mean difference reported, not clinically interpretable.
- RCT4 (86 patients) with similar results, 2-month wound cosmesis [100-point visual analogue scale (VAS), higher=better]: 56 skin-glue versus 63 tape (difference not likely clinically meaningful).5
- Patient satisfaction, dehiscence, infection, or time-to-perform-closure:3 No difference.
- Clinician-rated cosmesis (3 RCTs, 173 wounds):3 Standard mean difference reported, not clinically interpretable.
- Skin-glue versus tape/staples/sutures combined: One systematic review (13 RCTs, 1322 lacerations),6 adult/children lacerations:
- Pain VAS (100-point, lower=better) (1 RCT, 136 patients): 11 points lower with skin-glue.
- Time to perform closure (6 RCTs, 584 patients): Skin-glue 4.7 minutes faster.
- Cosmetic appearance, dehiscence, infection: No difference.
- Absorbable versus non-absorbable sutures: Two systematic reviews (7-11 RCTs, 702-751 patients), children/adults with lacerations/incisions:7,8
- Cosmesis, patient satisfaction, dehiscence: No difference.7,8
- Adverse events:3 No difference in infection (4-7.6%).
- Limitations: Differing rating scales/outcomes, blinding of assessors unclear/unknown.3,4
CONTEXT
- Simple lacerations can be cleaned with tap water9 and repaired with clean non-sterile gloves without increased infection.10
- Skin-glue: Octylcyanoacrylate (DermabondTM) or butylcyanoacrylate (KrazyglueTM).
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Useful
Sutures are seem better if larger punch biopsies
This helps in chosing the method of closure. The quicker easier way maybe better for children.
Very interesting but never tried glue ..have true steri strips with good results
Very interesting. I never used glue always sutures
Interesting. I almost always have been using steri-strips.