Surgical glue may compromise wound cosmesis: compared with sutures.
SEATTLE -- Surgical glues should be used sparingly in pediatric dermatology because they can be more likely than sutures to result in hypertrophic scars, Dr. Bari Cunningham said at the annual meeting of the Society for Pediatric Dermatology.
There has been a lot of enthusiasm about cyanoacrylate surgical glue, and some have predicted that it will eventually replace sutures, noted Dr. Cunningham, an expert in pediatric dermatologic surgery at Children's Hospital and Health Center, San Diego. But that enthusiasm is out of proportion to the glue's actual utility.
Wounds that have to be closed with some tension may not fare as well cosmetically when surgical glue is used, Dr. Cunningham said her own research has shown.
Most procedures done on children are going to be excisional and therefore are going to produce wide wounds that require some tension to pull them closed.
Dr. Cunningham's research involved randomizing 48 pediatric patients to either subcutaneous suturing and then 2-octyl cyanoacrylate (Dermabond), or to a suture-only closure. A total of 52 wounds were evaluated.
At 2 weeks after closing the wounds, there was no difference in wound erythema, dehiscence, infection, or pruritus. But at 2 months, independent evaluators rated the cosmesis of the wounds closed only with sutures as significantly better than those closed with 2-octyl cyanoacrylate, and actual scar hypertrophy was noted in 5 of 24 (21%) wounds closed with 2octyl cyanoacrylate, compared with only 3 of 28 (11%) wounds closed with sutures.
Dr. Cunningham said she uses the following rule of thumb: If you would choose a 3-0 or 4-0 polypropylene suture to close a wound, that wound requires too much tension to use glue. Other disadvantages of glue include: the cost (about $30 per vial), the frequent necessity of subcutaneous sutures (because the glue cannot be placed inside a wound due to the risk of a foreign body reaction), and that the glue can be picked off or dissolved with petrolatumbased products such as Polysporin.
There are times when glue is the better option. It works well for simple, incisiontype procedures, such as removing dermoid cysts. Glue can keep out water (so patients can get the wound wet), and it is ideal with a wound in the diaper area. It may have antimicrobial properties.
BY TIMOTHY F. KIRN
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|Title Annotation:||Clinical Rounds|
|Author:||Kirn, Timothy F.|
|Date:||Nov 1, 2003|
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