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;
  1. Does one technique provide better physician and patient reported cosmetic outcomes?
  2. Does one technique result in reduced adverse events, post-operative pain or improved cost efficiency?
  3. Does any technique have a beneficial effect on patient QOL or body image?