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.