Primary outcome measure
Four out of five papers comparing sutures and staples noted no significant difference in wound cosmesis, with one (Oswal) finding a significantly superior cosmetic outcome favouring staples at 3 months (p=0.03). No studies found a significant difference in cosmetic outcomes between sutures or tissue adhesives. Three papers compared cosmetic outcomes using a visual analogue scale only one using a validated assessment tool, the Hollander wound evaluation score (HWES). A “good”, “moderate” and “poor” observer assessment scale was used in 3 papers. Six studies used independent observers, of which 4 reported blinding of these assessors. Only Bozkurt used a patient orientated assessment, using a “yes/ no” question for satisfaction with appearance. Timing of follow-up assessments varied wildly, from date of removal to 180 days. A summary of cosmetic outcomes is given intable 3 .