Intervention Review

Tissue adhesives for traumatic lacerations in children and adults

  1. Ken J Farion1,*,
  2. Kelly F Russell2,
  3. Martin H Osmond3,
  4. Lisa Hartling4,
  5. Terry P Klassen5,
  6. Tamara Durec6,
  7. Ben Vandermeer7

Editorial Group: Cochrane Wounds Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 30 SEP 2007

DOI: 10.1002/14651858.CD003326

Database Title

Additional Information

How to Cite

Farion KJ, Russell KF, Osmond MH, Hartling L, Klassen TP, Durec T, Vandermeer B. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003326. DOI: 10.1002/14651858.CD003326.

Author Information

  1. 1

    University of Ottawa, Departments of Pediatrics and Emergency Medicine, Ottawa, Ontario, Canada

  2. 2

    Alberta Children's Hospital, Department of Paediatrics, Calgary, Alberta, Canada

  3. 3

    University of Ottawa, Department of Pediatrics, Ottawa, Ontario, Canada

  4. 4

    Evidence-based Practice Centre, University of Alberta, Edmonton, Alberta, Canada

  5. 5

    University of Alberta, Department of Pediatrics, Edmonton, Alberta, Canada

  6. 6

    Evidence-based Practice Centre, Aberhart Centre One, Room 9418, Edmonton, Alberta, Canada

  7. 7

    Alberta Research Centre for Child Health Evidence & University of Alberta Evidence-based Practice Centre, Department of Pediatrics, Edmonton, Alberta, Canada

*Ken J Farion, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada. farion@cheo.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Tissue adhesives have been used for many years to close simple lacerations as an alternative to standard wound closure (sutures, staples, adhesive strips). Potential advantages over standard wound closure include ease of use, decrease in pain, time to apply and not requiring a follow-up visit for removal. Whilst studies have compared tissue adhesives with standard wound closure to determine the cosmetic outcome and other secondary outcomes no systematic review was previously available, so that no generalizable, definitive answers about the effectiveness of tissue adhesives existed.

Objectives

To summarize the best available evidence for the effects of tissue adhesives on the healing of traumatic lacerations in children and adults.

Search methods

We searched the Cochrane Wounds Group Specialised Trials Register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2007), MEDLINE (1950 to October Week 1 2007), EMBASE (1980 to 2007 Week 41), CINAHL (1982 to October Week 2 2007), Web of Science - Science Citation Index (1975 to April 29, 2007), seven clinical trial registries, and reference lists of articles. We also contacted manufacturers and researchers in the field.

Selection criteria

Randomised controlled trials comparing tissue adhesives with standard wound closure or one tissue adhesive compared with another tissue adhesive for acute, linear, low tension, traumatic lacerations in an emergency or primary care setting.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Information on adverse effects was collected from the trials. Outcomes of cosmesis (subgroups of age, wound location and need for deep sutures), pain, procedure time, ease of use, and complications were analysed separately for two comparisons: 1) tissue adhesive compared with standard wound closure; and 2) tissue adhesive compared with another tissue adhesive.

Main results

Thirteen studies were included in this review. Eleven studies compared a tissue adhesive with standard wound closure. No significant difference was found for cosmesis at any time point examined, using either Cosmetic Visual Analogue Scale (CVAS) or Wound Evaluation Score (WES). Pain scores (Parent VAS weighted mean difference (WMD) -13.4 mm; 95% CI -20.0 to -6.9) and procedure time (WMD -4.7 minutes; 95% CI -7.2 to -2.1) significantly favoured tissue adhesives. Only one study reported on ease of use, favouring standard wound closure. Small but statistically significant risk differences were found for dehiscence (favouring standard wound care, Number Needed to Harm (NNH) 40; 95% CI 20 to 1168) and erythema (favouring tissue adhesive, NNH 10; 95% CI 5 to 239). Other complications were not significantly different between treatment groups.

Two studies compared tissue adhesives. One study compared two different tissue adhesives, butylcyanoacrylate with octylcyanoacrylate, for pediatric facial lacerations and found no significant difference for cosmesis, pain, procedure time, or complications. Another study compared two different formulations (viscosities) of octylcyanoacrylate to assess the incidence of product migration as a proxy for complications of application; the high-viscosity product migrated on significantly fewer participants.

Authors' conclusions

Tissue adhesives are an acceptable alternative to standard wound closure for repairing simple traumatic lacerations. They offer the benefit of decreased procedure time and less pain, when compared to standard wound closure. A small but statistically significant increased rate of dehiscence with tissue adhesives is observed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Tissue adhesives for traumatic lacerations in children and adults

Cuts (lacerations) often need to be closed to ensure proper healing, and prevent infection or unattractive scarring. Wounds may be closed with stitches (sutures), staples, tapes or glue (tissue adhesive). The review found that glue is an excellent substitute for stitches, staples or tapes to close simple cuts. Glue causes less pain, is quicker and needs no follow up for removal. A slightly higher number of cuts may break open (dehisce) after being glued, compared to cuts closed with stitches, staples or tapes. Though there are a few different types of glue available, no one glue seems to be superior.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

組織粘合劑用於小孩和成人外傷性撕裂

組織粘合劑用於縫合簡單撕裂傷已行之有年，做為標準傷口縫合 (縫合，縫合釘和膠粘條) 的取代選擇。相較於標準傷口縫合其潛在優點包含容易使用，減輕疼痛及使用所需要時間少，且不需回診拆除。然而沒有過去研究和傳統傷口縫合比較組織粘合劑以決定美觀程度和其他次藥的結果因此沒有有關組織粘合劑一般化和絕對的答案。

目標

總結現有最好的證據，判定小孩和成人外傷撕裂時，使用的創傷組織粘合劑是否有效。

搜尋策略

我們搜尋 Cochrane Wounds Group Specialised Trials Register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2007), MEDLINE (1950 to October Week 1 2007), EMBASE (1980 to 2007 Week 41), CINAHL (1982 to October Week 2 2007), Web of Science  Science Citation Index (1975 to April 29, 2007) ， 七個臨床試驗、臨床試驗登記，以及文獻參考清單。 clinical trial registries, and reference lists of articles. 我們也聯絡製造廠商和此領域的學者。

選擇標準

隨機對照試驗於急診室或初級醫療場所以組織粘合劑比較傳統傷口縫合或其他適用於急性、線性低張的外傷性撕裂傷口。

資料收集與分析

兩個作者獨立評估試驗品質和擷取數據。聯絡研究作者取得近一步資料。從試驗收集不良影響。以美容 (次分組:依年紀，傷口位置和深層縫合的需要) 、，疼痛，處理時間，使用簡易性和併發症分別分析成果，作為組織粘合劑和1) 標準傷口縫合和以比較， 2) 其他組織粘合劑的比較。

主要結論

本回顧納入13個試驗。11個研究和傳統組織縫合比較。以Cosmetic Visual Analogue Scale (CVAS) 或Wound Evaluation Score (WES) 於任何時間點檢查美容情況沒有顯著差異。疼痛指數 (Parent VAS weighted mean difference (WMD) −13.4 公釐; 95% CI −20.0 to −6.9) 和處理時間 (WMD −4.7 minutes; 95% CI −7.2 to −2.1) 明顯有利於組織粘合劑。只有一項研究報導使用簡易性傾向傳統傷口縫合。裂開指標發現雖統計上顯著小的風險差 (傾向傳統傷口縫合，Number Needed to Harm (NNH) 40; 95% CI 20 to 1168) ，以即紅斑出現 (傾向組織粘合劑，NNH 10; 95% CI 5 to 239) 。其他併發症於治療組間沒有顯著差異。兩個研究比較組織粘合劑。一個比較兩種不同組織粘合劑 (butylcyanoacrylate和 octylcyanoacrylate) 用於小兒顏面撕裂傷，發現在傷口外觀，疼痛，處理時間或併發症都沒有顯著差異.。另一個研究比較octylcyanoacrylate的不同成分 (黏性) ，以評估產品移動的發生率當作為使用的併發症的代理在明顯少數參與者身上高黏性產品明顯移動者。

作者結論

於縫合簡單撕裂傷，使用組織粘合劑是可接受的替代傳統傷口縫合的選擇。組織粘合劑與傳統傷口縫合相比組織粘合劑提供好處包含減少處理時間和疼痛。但使用組織粘合劑存在明顯增加小的裂開的比例。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

粘合劑可能比逢線，釘針或膠布好，有助於修復簡單需要縫合的切傷。切傷 (撕裂傷) 通常需要縫合以確保可以適當的癒合和預防感染，或沒有吸引力的疤痕。傷口可以用縫線 (縫合) ，膠布或粘合劑 (組織粘合劑) 縫合。本回顧發現粘合劑可完美替代縫線，釘針或膠布縫合切傷。粘合劑引起較少疼痛，比較快且不需回診移除。相較於縫合，釘針或膠布比較，粘合劑有稍微較高的切口膠合後可能裂開。雖然只有少數不同的膠合劑可以使用，燃沒有一項較佳。

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