Introduction
Surgical scars in head and neck operations are frequently extensive in
order to facilitate successful excision of tumour margins and bulky
nodal disease. Post-operatively, the impact of these scars on patient’s
mental wellbeing can be overlooked, as these scars are more difficult to
conceal compared to those left by operations on the thorax, abdomen, and
limbs. Previous studies have demonstrated that scars can have a
detrimental impact on a patient’s body image and quality of life (QOL)
regardless of scar location. Moreover, wound complications such as
infections and keloids may be much more visible in the neck, further
exacerbating body confidence issues. It has been established that in
subgroups including young female, Asian, and Afro-Caribbean patients,
that this can potentially lead to body dysmorphia.
When closing the skin, there is a wealth of options available, including
sutures, surgical staples, tissue adhesives (most commonly 2‐octyl
cyanoacrylate), and surgical tape (steri-strips). The efficacy of each
method appears consistent within varying specialties, with systematic
reviews of General surgical, Orthopaedic, Obstetric, Gynaecological, and
Vascular procedures noting little difference in cosmetic outcomes. Their
use is therefore dictated by surgeon preference and surgical operating
time. Within the head and neck, transcervical scars used in
thyroidectomy and parathyroidectomy have exhibited better short-term
cosmetic outcomes when using subcuticular sutures compared to staples.
Despite this work, no previous systematic reviews have assessed the
effect of tissue adhesives, sutures, and staples on the appearance of
scars following other major head and neck operations such as neck
dissection and salivary gland resection. Resultantly, the aim of this
systematic review is to answer the following questions regarding these
wound closure techniques in head and neck surgery;
- Does one technique provide better physician and patient reported
cosmetic outcomes?
- Does one technique result in reduced adverse events, post-operative
pain or improved cost efficiency?
- Does any technique have a beneficial effect on patient QOL or body
image?