European Journal of Cardiovascular Medicine

Suture remains the prevailing method for wound closure, having been employed for numerous millennia. The evolution of suture materials has progressed from basic, rudimentary materials to a diverse range of options that are specifically designed for the tissue to be sutured. Sutures do possess certain disadvantages. The presence of needles in sutures exposes both the surgeon and the helper to the risk of needle stick injuries. In order to facilitate the removal of the sutures, it is necessary for the patient to revisit the hospital. Sutures are employed to suture wounds, resulting in markings that are oriented perpendicular to the line of incision. These limitations encouraged researchers to seek more efficient methods for healing wounds [1, 2].

A wound is described as an injury to any of the tissues of the body, particularly when it is inflicted by physical methods and results in the interruption of continuity. Wound healing is an inherent and impromptu process. When tissue is severely disrupted, it cannot heal naturally without complications or potential disfigurement of dead tissue. In such cases, it is necessary to remove foreign bodies, treat the infection, and securely hold the tissue in place until the healing process gives the wound enough strength to withstand stress without the need for mechanical support. Sutures, staples, clips, skin closure strips, or topical adhesives are often employed methods for approximating wounds. Tissue adhesives offer several benefits compared to traditional sutures, such as user-friendly application, exceptional bacteriostatic properties, reduced repair time, and favorable cosmetic results [2-4]. Surgical tissue adhesives that are presently accessible can be classified into two main categories: fibrin tissue adhesives and cyanoacrylates. The topic of surgical tissue adhesives generally include fibrin tissue adhesives and cyanoacrylates, but it is important to note that these two substances have distinct indications and modes of action [3-5].

Currently, there are two attractive alternatives available, namely adhesive glue and adhesive tapes. Adhesive glue has been utilized for the treatment of traumatic wounds for more than thirty years since its initial identification. The topic of adhesive glue for surgical incisions has garnered significant attention in recent times. There exists a limited number of limited-scale clinical trials that substantiate this assertion. Another alternative for wound closure is the utilization of sticky tape. Compared to glue and sutures, the tape is much more cost-effective to buy, and a prior investigation revealed it to be a prompt and economical alternative [4-6]. The comparative analysis of the three wound closure procedures has been limited to a limited number of research.

The primary objective of the study was to compare and evaluate the efficacy of sutures, adhesive glue, and adhesive tape in the management of surgical incision wound closure.

From January 2007 to December 2007, researchers at the Department of General Surgery, Hi-Tech Medical College, Bhubaneshwar, India, documented the closure procedure for each patient using a randomization chart. This study was conducted after obtaining the necessary approvals and consent from patients. Sixty coupons were therefore produced. Factors such as numbers, wound dehiscence, infection, aesthetics, visual analogue score, Hollander wound evaluation score, and surgeon and patient satisfaction were taken into account.

 Inclusion criteria:

• Three randomly allocated groups of elective hernia surgery patients had their skin incisions repaired with suture, glue, or tape.

 Exclusion criteria:

• Patients with keloid or hypertrophic scars, diabetes, TB, steroid use, connective tissue problems, medication allergies, or cyanoacrylate or formaldehyde allergies

The average duration for the suture method was 293.1 seconds, while the sticky glue method took 265.15 seconds and the adhesive tape method took 226.85 seconds. The application of adhesive tape required considerably less time compared to the use of suture and glue (P = 0.0067). No significant disparity was observed in the duration needed for the application of adhesive and suture.

Table 1: Time

Table 2: Score for the Hollander wound assessment on Day 1

The Hollander wound evaluation score did not exhibit any statistically significant variation among the three groups on the first day.

Table 3: Second day of the Hollander wound examination

There was no statistically significant disparity observed in the Hollander wound evaluation score among the three groups on the second day.

Table 4: The third day of the Hollander wound examination

There was no statistically significant disparity observed in the Hollander wound evaluation score among the three groups on the third day.

Table 5: The wound's Hollander score on day seven

 By day 7, there was no noticeable disparity in the Hollander wound evaluation scores among the three groups.

The assessment of wound closure strategies necessitates the consideration of wound dehiscence. An optimal system would effectively mitigate wound dehiscence during the healing process, particularly in the first stages. The occurrence of dehiscence is infrequent until the incision becomes infected, as sutures are securely fastened and knotted [7-9]. Wound dehiscence in the patient treated with adhesive glue in this study may have been caused by excessive skin stretching at the incision site during mobilization or incorrect glue application. Research on dehiscence commenced. The rates of dehiscence decreased significantly and ceased when appropriate closure and patient restriction were implemented. Surgical wound infections are prevalent and pose a significant risk to both patients and doctors. The doctor is unable to do infection screenings following many outpatient procedures [10-12].
The present study did not document any instances of wound infections. However, prior research has reported a range of 0% in the Maartense trial to 11% in the Malone study. Tissue adhesive glue inhibits the growth of bacteria, hence preventing infection. The efficacy of adhesive glue in reducing infection rates has not been demonstrated. The significance of time in surgical procedures cannot be overstated. The efficiency of modern surgery has been enhanced through the reduction of process durations. Gastrointestinal staplers decrease the duration of bowel anastomosis in comparison to sutures. The closure of wounds has shown improvement [12, 13].
Adhesive tapes exhibit a higher rate of wound closure compared to stitches or glue. Both suture and sticky glue necessitate comparable durations. The application of adhesive was mainly influenced by hemostasis in the borders of the skin. Hemostasis is a necessary step prior to the application of adhesive glue. In a prior investigation, it was observed that sutures exhibited the slowest closure rate, followed by adhesive glue and tape. Financial considerations are essential for any undertaking. Patients and doctors are burdened by high operational expenditures [13, 14].
Emerging advancements and methodologies frequently exhibit enhanced efficacy, but at a higher cost, until they get widespread use. Adhesive tapes were priced at a rate eight times lower than glue and three times lower than sutures. Nevertheless, the release of wound fluid caused the adhesive tapes to become moist following the surgery, necessitating their replacement by day seven. The expense of closing wounds and providing wound care may be higher. Glue is the most costly option, although it is also the most economical due to its minimal need for wound care and elimination of suture removal [14, s15]. The absence of scars is optimal. Surgical scars are enduring in nature. Doctors strive to achieve wound closures that are free from scars. Despite centuries of stitches, surgical scars have remained largely unchanged. In contrast to monofilament sutures, silk sutures exhibit visible suture marks when employed for the purpose of skin closure. Monofilament sutures have been found to mitigate scarring associated with aging procedures [15, 16].

Adhesive glue and tapes prevent the need for sutures and potential scars after surgery. The visual appearance of the scar was examined using the Modified Hollander Scar Evaluation Score and Visual Analogue Scale for Scar on postoperative days 1, 2, 3, 7, 30, and 90. There was no statistically significant difference observed in the Hollander scar evaluation among the three groups on days 1, 2, 3, or 7. After 30 days of surgery, sticky glue demonstrated superior performance compared to suture. To forecast the appearance of your scar in one year, consider examining its visual appearance on day 90, rather than on day 7 or 30. The suture method resulted in the most severe scar, whereas the sticky glue method yielded the most favorable outcome. The results of the Day 90 visual analog scale were consistent. Glue had superior performance compared to suture and adhesive tape on the visual analog scale at days 2, 3, and 30. The first day was ordinary. Prior studies have demonstrated that the efficacy of sticky glue cosmetic scars surpasses that of scars created using alternative techniques. A significant number of individuals choose for minimally invasive therapies over open surgery. Therefore, it is imperative to obtain favorable feedback from patients in order to evaluate the effectiveness of the wound closure system [16, 17].

A pre-validated questionnaire was administered on days 7, 30, and 90 post-surgery in order to evaluate patient satisfaction. Patients with bilateral hernia who underwent two surgeries were able to distinguish between them. Patients expressed the same level of happiness seven days following the procedure. Adhesive adhesive shown greater popularity compared to sutures or tape within the 30-day and 90-day postoperative period. The satisfaction gap may be attributed to the fact that patients are able to take baths earlier without the need to reapply the sticky glue [18, 19]. Every physician desires injury closure that is secure, efficient, and effortless. Adhesives consistently outperform sutures. Sutures received the lowest satisfaction scores on postoperative days 7, 30, and 90, followed by sticky glue and adhesive tape [20].

There is great promise for the future of surgical wound closure using adhesive glue and tapes. This study shows that adhesive glue is better than suture for wound closure since it offers these advantages. Surgeries aren't as attractive as these. Patients seem to be more receptive to these than sutures. Surgeons are more satisfied with their use than with sutures. Unlike with stitches, a return visit to the hospital after applying adhesive is unnecessary. On the other hand, there are downsides to employing adhesive glue. There is a huge price difference between the glue and the suture. According to the research, using adhesive glue for severe straining increases the likelihood of wound dehiscence. It is possible to prevent this with proper technique and careful attention to wound care.

Funding support:

Nil

Conflict of interest:

None

1. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT (May 2001). "A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation   in   the   management   of   bleeding   gastric varices". Hepatology 33 (5): 1060.
2. Chen WC, Hou MC, Lin HC, Chang FY, Lee SD (February 2000). "An endoscopic injection with N-butyl-2-cyanoacrylate used for colonic variceal bleeding: a case report and review of the literature". Am. J. Gastroenterol. 95 (2): 540–2.
3. Coulthard P, Esposito M, Worthington HV, van der Elst M, van Waes OJF, Darcey J. Tissue adhesives for closure of surgical incisions.Cochrane Database of Systematic Reviews 2005, Issue 5
4. Hollander JE, Singer AJ, Valentine S, Henry MC. Wound registry:Development and validation. Annals Emergency Medicine 1995;25:675–85.
5. Quinn J, Wells G, Sutcliffe T, Jarmuske M, Maw J, Stiell I, Johns P. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Annals of Emergency Medicine 1998;32(6):645–9.
6. Quinn, J., Wells, G., Sutcliffe, T., Jarmuske, M., Maw, J., Stiell, I., & Johns, P. (1997). A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. Jama, 277(19), 1527-1530.
7. Dowson, C. C., Gilliam, A. D., Speake, W. J., Lobo, D. N., & Beckingham, I. J. (2006). A prospective, randomized controlled trial comparing n-butyl cyanoacrylate tissue adhesive (LiquiBand) with sutures for skin closure after laparoscopic general surgical procedures. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 16(3), 146-150.
8. Chen, H. H., Tsai, W. S., Yeh, C. Y., Wang, J. Y., & Tang, R. (2001). Prospective study comparing wounds closed with tape with sutured wounds in colorectal surgery. Archives of surgery, 136(7), 801-803.
9. Stuart Enoch, David John Leaper. Basic Science of Wound Healing.Surgery. 2005: 23:2:37-42.
10. Cover HN, Joyner FB, Sheere NH. Chemistry and performance of cyanoacrylate adhesive. Journal of the Society of Plastic Surgery of England 1959;1:5–6.