Adhesive strips for the closure of surgical wounds: a systematic review and meta-analysis Presenting author: I Gkegkes, M Mavros, V Alexiou, G Peppas, M Falagas Vangelis G. Alexiou, MD, MSc General Surgery Trainee Northampton General Hospital, United Kingdom Research Fellow AIBS, Greece Alfa Institute of Biomedical Sciences Athens, Greece
Introduction Adhesive strips have been used in clinical practice, for surgical wound closure, during the last 50 years. However, their use has not been standardized nor given any specific indication. In practice, strips are most commonly used to manage simple traumatic lacerations, achieve early sutures or staples removal, support and reinforce loosely sutured wounds. Strips manufacturers advertise that their product is quite close to the definition of the ideal wound closure method; rapid, inexpensive, painless, limiting the chance of infection, and with optimal cosmetic results. Some surgeons are reluctant to use adhesive strips claiming that they are more prone to dehiscence especially for major surgical incisions and wounds with tension at highly contoured areas and/or areas of musculoskeletal movement. Sunday 21 November 2010 Strips vs sutures 2/14
Objective We sought to perform a meta-analysis of randomized controlled trials (RCTs) regarding the use of adhesive strips for surgical wound closure and compare them, in terms of clinical outcomes, and ease of application, to sutures and other closure materials. Sunday 21 November 2010 Strips vs sutures 3/14
Methods Systematically searched PubMed, Scopus and Cochrane Central Register of Controlled Trials All RCTs comparing adhesive strips to any other method of closure of superficial traumatic or surgical wounds were considered eligible for inclusion. There was no restriction on language and time of publication. Study design, year of publication, type of study population, surgical procedure, compared closure methods, wound or incision length, closure time, hospital stay, development of wound infection, patients satisfaction, pain on closure method application and on removal of the closure material, and other complications. Cosmesis data was extracted only if there was a valid cosmetic score and/or assessment by an objective evaluator. Wound dehiscence was defined as the reopening of the incision site after the wound closure, without the need of secondary closure. Sunday 21 November 2010 Strips vs sutures 4/14
Methods Quality appraisal according to the Jadad score for RCT randomization, blinding, reporting of withdrawals. Continuous variables were assessed using weighted mean difference (WMDs) and 95% confidence intervals (CIs), while for the assessment of dichotomous variables pooled odds ratios (ORs) and 95% (CIs) were calculated. Fixed effects model or DerSimonian random effects model was used based on heterogeneity testing. Sunday 21 November 2010 Strips vs sutures 5/14
Results study population A total of 18 studies were included in this meta-analysis. 2229 wounds in 2032 patients 15/18 studies reported on incisional surgical sites 3/18 reported on traumatic lacerations. Adhesive strips, sutures, and tissue adhesive glue were used to close 1040, 983, and 206 wounds, respectively. 11/18 compared strips to sutures 3/18 compared strips to sutures and tissue adhesives 1/8 adhesive strips to sutures and staples 1/18 study adhesive strips to sutures and simple sterile dressing Sunday 21 November 2010 Strips vs sutures 6/14
Closure time sutures vs strips Sunday 21 November 2010 Strips vs sutures 7/14
Infection strips vs sutures Sunday 21 November 2010 Strips vs sutures 8/14
Closure time & wound infection sutures vs tissue adhesive AIBS 2010 Sunday 21 November 2010 Strips vs sutures 9/14
Other complications sutures vs strips AIBS 2010 Sunday 21 November 2010 Strips vs sutures 10/14
Pain 7 evaluated pain post wound closure. considerable heterogeneity among the included studies regarding the scales and methods used for pain evaluation; ( Visual Analog Scale (VAS) score, 10-point scale, 4-point scale and a verbal scale assessment) Only 1 study reported significant difference between the compared groups regarding pain perception on follow up. In 2 studies significantly more analgesia was required in the sutures group. Sunday 21 November 2010 Strips vs sutures 11/14
Cosmesis 13 studies provided data regarding the cosmetic evaluation of wound closure using either VAS score, a 4-point scale, a 9-point, and a 10-point scales or verbal scales In 5 studies the use of adhesive strips was associated with a superior cosmetic outcome compared to other wound closure methods, both on short-term and long-term follow up. 2 studies reported inferior results compared to the sutures group on follow up. Sunday 21 November 2010 Strips vs sutures 12/14
Discussion - Conclusions This meta-analysis provides evidence that the cheaper technique of adhesive strips is faster than, and as safe as sutures, staples and adhesive glue for the management of simple lacerations. Moreover strips may offer better results in terms of post-closure pain and cosmesis compared to other techniques. However, available evidence, on wound dehiscence and need for resuturing, is not enough to draw any safe conclusions for larger wounds, wounds with tension at highly contoured areas or areas of musculoskeletal movement. Additional studies of adhesive strips are needed, focusing on the rate of dehiscence and resuturing in regard to the extent (depth, width, and shape) and the location of the incision or the laceration. Sunday 21 November 2010 Strips vs sutures 13/14
Sunday 21 November 2010 Strips vs sutures 14/14