Glue is better than sutures for facial lacerations in children
Date First Published:
March 1, 2000
Last Updated:
May 16, 2001
Report by:
Simon Carley, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Mohammed Al Zarad, Manchester Royal Infirmary
Three-Part Question:
In [children with facial lacerations requiring closure] is [wound glue better than sutures] at [improving cosmetic outcome and reducing the distress of the procedure]?
Clinical Scenario:
A 3 year old girl presents to the emergency department after catching her face on the edge of a table. She has a 2.5 cm laceration to the cheek which requires closure. The wound is not suitable for steristrips. The parents are very worried abbout her having stitches and also about scarring. You wonder whether glue is the best option for this child.
Search Strategy:
Medline 1966-07/99 using the OVID interface.
Search Details:
({exp fibrin tissue adhesive OR exp tissue adhesives OR exp enbucrilate OR exp cyanoacrylates OR wound glue$.mp OR histoacryl.mp OR octylcyanoacrylate$ OR butylcyanoacrylate$} AND {exp wounds and injuries OR wound$.mp OR lacerate$.mp OR laceration$.mp} AND maximally sensitive RCT filter) LIMIT to human AND english.
Outcome:
138 papers found of which 130 irrelevant or of insufficient quality for inclusion. The remaining 8 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A randomised, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Quinn JV, Drzewiecki A, Li MM, et al. 1993 Canada. | 81 children with facial lacerations less than 4 cm in length and 0.5 cm wide. Sutures vs histocaryl blue. |
PRCT | Cosmesis at 3 months | No significant difference | |
| Parent view of procedural pain | Less with glue (43.7 vs 24.7mm) | ||||
| Time taken for procedure | Shorter with glue (15.6 min vs 7 min) | ||||
| Laceration repair using a tissue adhesive in a children's emergency department. Bruns TB, Simon HK, McLario DJ, Sullivan KM, Wood RJ, Anand KJ. 1996 USA. | 61 children aged 1 - 17 years with lacerations less than 5 cm. Sutures vs histoacryl blue. |
PRCT | Cosmesis at 2 months | No significant difference | Preliminary report of reference 4. Local anaesthetic technique was not controlled. |
| Parent view of procedural pain | Less with glue (29mm vs 8mm) | ||||
| Time taken for procedure | Shorter with glue (17 min vs 7 min) | ||||
| A randomised trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. Quinn J, Wells G, Sutcliffe T, et al. 1997 USA. | 130 adults with facial and selected extremity lacerations (not hands and feet). Sutures vs octylcyanoacrylate glue. |
PRCT | Cosmesis at 3 months | No significant difference | Preliminary report of reference 5. Adults. |
| Time taken for procedure | Shorter with glue (12.4 min vs 3.6 min) | ||||
| Time to healing | No significant difference | ||||
| Long term appearance of lacerations repaired using a tissue adhesive. Simon HK, McLario DJ, Bruns TB, Zempsky WT, Wood RJ, Sullivan KM. 1997 USA. | 61 children aged 1 - 17 years with lacerations less than 5 cm. Sutures vs histoacryl blue. |
PRCT | Cosmesis at 1 year | No significant difference | Only 32 of 61 children were followed up. |
| Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month and 1-year cosmetic outcome. Quinn J, Wells G, Sutcliffe T, et al. 1998 USA. | 130 adults with facial and selected extremity lacerations (not hands and feet). Sutures vs octylcyanoacrylate glue. |
PRCT | Cosmesis at 1 year | No significant difference | Only 77 of 130 patients were followed up. Adults. |
| Prospective, randomised, controlled trial of tissue adhesive (2-octylcyanoacrylate) vs standard wound closure techniques for laceration repair. Stony Brook Octylcyanoacrylate Study Group. Singer AJ, Hollander JE, Valentine SM, Turque TW, McCuskey CF, Quinn JV. 1998 USA. | 124 patients over 1 year of age with recent non-bite, non-crush lacerations. Standard wound closure (sutures or steristrips) vs octylcyanoacrylate glue. |
PRCT | Cosmesis at 3 months | No significant difference | Wound assessments were not blinded. |
| Patients wound rating | No significant difference | ||||
| Use of irrigation or scrub | No significant difference | ||||
| Need for local anaesthesia | Less with glue (89% vs 21%) | ||||
| Wound complications | 1 infection and 2 dehisences in the glue group | ||||
| Randomised trial of histoacryl blue tissue adhesive glue versus suturing in the repair of paediatric lacerations. Barnett P, Jarman FC, Goodge J, Silk G, Aickin R. 1998 Australia. | 163 children over 4 years old with recent lacerations less than 5 cm in length. Sutures vs histoacryl blue. |
PRCT | Cosmesis at 3 months | No significant difference | Poor follow up wound assessments were not blinded. |
| Cosmesis at 12 months | No significant difference | ||||
| Time taken for wound repair | Less with glue (0-2 min vs 6-10 min) | ||||
| Carer view of procedural pain | Less with glue | ||||
| Childs view of procedural pain | No difference | ||||
| Wound complications | No difference | ||||
| A new tissue adhesive for laceration repair in children. Bruns TB, Robinson BS, Smith RJ, et al. 1998 USA. | 83 children with lacerations. Sutures or staples vs octylcyanoacrylate. |
PRCT | Cosmesis | No significant difference | 20% of patients not followed up. |
| Time taken for wound repair | Less with glue (5.8 min vs 2.9 min) | ||||
| Parents view of procedural pain | Less with glue |
Author Commentary:
There are a number of well designed PRCTs that directly address the 3 part question posed, and a number that are relevant. Cosmesis is a difficult outcome since true blinding is impossible because of suture marks. Glue is quicker to apply, causes less procedural pain and gives equivalent cosmetic results to sutures. One trial shows a higher wound complication rate; this emphasises the point that glued wound require the same diligent as wounds that are to be sutured.
Bottom Line:
Glue is the wound closure method of choice in recent lacerations to the face in children.
References:
- Quinn JV, Drzewiecki A, Li MM, et al.. A randomised, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations.
- Bruns TB, Simon HK, McLario DJ, Sullivan KM, Wood RJ, Anand KJ.. Laceration repair using a tissue adhesive in a children's emergency department.
- Quinn J, Wells G, Sutcliffe T, et al.. A randomised trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations.
- Simon HK, McLario DJ, Bruns TB, Zempsky WT, Wood RJ, Sullivan KM.. Long term appearance of lacerations repaired using a tissue adhesive.
- Quinn J, Wells G, Sutcliffe T, et al.. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month and 1-year cosmetic outcome.
- Singer AJ, Hollander JE, Valentine SM, Turque TW, McCuskey CF, Quinn JV.. Prospective, randomised, controlled trial of tissue adhesive (2-octylcyanoacrylate) vs standard wound closure techniques for laceration repair. Stony Brook Octylcyanoacrylate Study Group.
- Barnett P, Jarman FC, Goodge J, Silk G, Aickin R.. Randomised trial of histoacryl blue tissue adhesive glue versus suturing in the repair of paediatric lacerations.
- Bruns TB, Robinson BS, Smith RJ, et al.. A new tissue adhesive for laceration repair in children.