Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials.
OBJECTIVE
To summarize the best available evidence for the effect of tissue adhesives (TAs) in managing traumatic lacerations in children and adults.


METHODS
A search was conducted using the Cochrane Controlled Trials Register, Medline, and EMBase for relevant studies. The authors also searched the citations of selected studies and contacted relevant authors and manufacturers. The search included randomized controlled trials (RCTs) comparing a TA versus standard wound closure (sutures, staples, adhesive strips) (SWC) or two TAs for acute, linear, low-tension, traumatic lacerations in an emergency or primary care setting. Data were extracted by one reviewer and checked for accuracy by a second reviewer. Two reviewers independently assessed masked copies for quality. Outcomes of cosmesis (subgroups of age, wound location, and need for deep sutures), pain, procedure time, ease of use, and complications were analyzed separately for two comparisons: 1). TA versus SWC; and 2). TA versus TA.


RESULTS
Eight studies compared a TA with SWC. No significant difference was found for cosmesis at any time point examined. Subgroup analysis was possible only for age; no significant difference was found. Pain scores [Parent Visual Analogue Scale weighted mean difference (VAS WMD) = -15.7 mm; 95% CI = -21.9 to -9.5] and procedure time (WMD = -5.7 minutes; 95% CI = -8.2 to -3.1) significantly favored TAs. Small, statistically significant risk differences were found for dehiscence [favoring SWC; number needed to harm (NNH) = 25; 95% CI = 14 to 100] and erythema (favoring TAs; NNH = 8; 95% CI = 4 to 100). Only one study compared two TAs (butylcyanoacrylate versus octylcyanoacrylate) for pediatric facial lacerations. No significant difference was found for cosmesis, pain, procedure time, or complications.


CONCLUSIONS
TAs are an acceptable alternative to SWC for simple traumatic lacerations. No difference in cosmesis was found between TAs and SWC, or between different TAs. Tissue adhesives offer the benefits of decreased procedure time and less pain, compared with SWC. A small increased rate of dehiscence with TAs must be considered when choosing the closure method (NNH = 25).
Farion
Ken J
KJ
Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada. farion@cheo.on.ca
Osmond
Martin H
MH
Hartling
Lisa
L
Russell
Kelly F
KF
Klassen
Terry P
TP
Crumley
Ellen
E
Wiebe
Natasha
N
D002986:Clinical Trials as Topic; D006801:Humans; D022125:Lacerations / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D014014:Tissue Adhesives