Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department

응급실 얼굴 열상 환자에서 Modified Hollander 점수에 의한 조직 접착제 사용과 봉합사를 이용한 봉합 후 결과 비교

  • Hong, Suk-Ho (Department of Emergency Medicine, Eulji University) ;
  • Yang, Young-Mo (Department of Emergency Medicine, Eulji University) ;
  • Lee, Jang-Young (Department of Emergency Medicine, Eulji University) ;
  • Lee, Won-Suk (Department of Emergency Medicine, Eulji University) ;
  • Bark, Koung-Nam (Department of Emergency Medicine, Eulji University) ;
  • Yang, Hee-Bum (Department of Emergency Medicine, Eulji University)
  • 홍석호 (을지대학교 의과대학 응급의학교실) ;
  • 양영모 (을지대학교 의과대학 응급의학교실) ;
  • 이장영 (을지대학교 의과대학 응급의학교실) ;
  • 이원석 (을지대학교 의과대학 응급의학교실) ;
  • 박경남 (을지대학교 의과대학 응급의학교실) ;
  • 양희범 (을지대학교 의과대학 응급의학교실)
  • Received : 2011.09.23
  • Accepted : 2011.10.28
  • Published : 2011.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl$^{(R)}$ (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. Method: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl$^{(R)}$) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar) Result: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant ($p$ <0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. Conclusion: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

Keywords

References

  1. Park JO, Shin SD, Song KJ, Ahn KO, Hong KJ, Suh GJ. Factor for The Dissatisfaction of Patient for Emergency Department Services. J Korean Soc Emerg Med 2007;18:97-106.
  2. Kim HJ, Ha YL, Kim YS, Kim JH, Kim SC, Kim JC, et al. Tissue Adhesive versus Simple Suture for Wound Management in Children under 5 years of Age in the Emergency Department. J Korean Soc Emerg Med 2003;14:508-513.
  3. Zempsky WT, Parrotti D, Germ C, Nichols J. Randomized Controlled Comparison of Cosmetic Outcomes of Simple Facial Lacerations closed with Steri-strip (TM) skin closure or Dermabond (TM) Tissue Adhesive. Pediatr Emerg Care 2004;20:519-524. https://doi.org/10.1097/01.pec.0000136068.45198.ae
  4. Koh KS, Jung YW, Yoon SY, Hong SJ. Application of 2-Octylcyanoacrylate ($Dermabond^{(R)}$) on the incisional wound of thyroidectomy. J Korean Soc Aesth Plast Surg 2002;8:57-60.
  5. Magee WP Jr, Ajkay N, Githae B, Rosenblum RS. Use of octyl-2-cyanoacrylate in cleft lip repair. Ann Plast Surg 2003;50:1-5. https://doi.org/10.1097/00000637-200301000-00001
  6. Bhalla RK, Lesser THJ. Simple, painless, cosmetic closure of endaural incisions. J Laryngol Otol 2003;117:67-68.
  7. Kim YO, Use of cyanoacrylate in facial bone fractures. J Craniofacial Surg 1997;8:229. https://doi.org/10.1097/00001665-199705000-00017
  8. Toriumi DM, O'Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg 1998;102:2209-2219. https://doi.org/10.1097/00006534-199811000-00062
  9. Quinn JV, Drzewiecki A, Li MM, Stiell IG, Sutcliffe T, Elmslie TJ. A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann Emerg Med 1993;22:1130-1135. https://doi.org/10.1016/S0196-0644(05)80977-1
  10. Toriumi DM, Raslan WF, Friedman M, Tardy ME. Histotoxicity of cyanoacrylate tissue adhesives: A comparative study. Arch Otolaryngol. Head Neck Surg 1990;116:546-550. https://doi.org/10.1001/archotol.1990.01870050046004
  11. Otilia C, Judd EH. Management of lacerations in the emergency department. Emerg Med Clin N Am 2003;21:205-231.
  12. Koh KS, Yoon SY, Ohk JJ. Use of 2-Octylcyanoacrylate ($Dermabond^{(R)}$) for repair of pediatric facial lacerations. J Korean Soc Cleft Palate Cranifac Assoc 2002;3:137-40.
  13. Gennari R, Rotmensz Z, Ballardini B, Scevola S, Perego E, Zanini V, et al. A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery. Surgery 2004;136:593-599. https://doi.org/10.1016/j.surg.2004.02.015
  14. Jallali N, Haji A, Watson CJ. A prospective randomized trial comparing 2-octyl cyanoacrylate to conventional suturing in closure of laparoscopic cholecystectomy incisions. J Laparoendosc Adv Surg Tech 2004;14:209-211. https://doi.org/10.1089/lap.2004.14.209
  15. Matin SF. Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. J Am Coll Surg 2003;196:845-853. https://doi.org/10.1016/S1072-7515(03)00119-4
  16. McKinley SH, Yen MT. Octyl-2-cyanoacrylate tissue adhesive in external dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2005;21:197-200. https://doi.org/10.1097/01.IOP.0000161715.69963.9C
  17. Sebesta MJ, Bishoff JT. Octylcyanoacrylate skin closure in laparoscopy. JSLS 2004;8:9-14.
  18. Choi JW, Hyun KB, Kim YO, Park BY. Comparing Conventional Suture Method Versus Wound Closure Using Tissue Glue (Histoacryl Blue(R)): A Prospective Randomized Clinical Trial. J Korean Soc Plast Reconstr Surg 2005;32:19-23.
  19. Salvatore C, Leonello T. Use of skin glue versus traditional wound closure methods in brain surgery: A prospective, randomized, controlled study. Journal of Clinical Neuroscience 2009;16:535-539. https://doi.org/10.1016/j.jocn.2008.08.004
  20. Karcioglu O, Goktas N, Coskun F, Karaduman S, Menderes A. Comparison of tissue adhesive and suturing in the repair of lacerations in the emergency department. European journal of emergency medicine 2002;9:155-158. https://doi.org/10.1097/00063110-200206000-00010
  21. Ong CCP, Jacobsen AS, Joseph VT. Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: A prospective, randomized trial. Pediatric Surg Int 2002;18:553-555. https://doi.org/10.1007/s00383-002-0728-0
  22. Toriumi DM, O'Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg 1998;102:2209-2219. https://doi.org/10.1097/00006534-199811000-00062
  23. McKinley SH, Yen MT. Octyl-2-cyanoacrylate tissue adhesive in external dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2005;21:197-200. https://doi.org/10.1097/01.IOP.0000161715.69963.9C
  24. Mete KB, Levent S. The use of cyanoacrylates for wound closure in head and neck surgery. Eur Arch Otorhinolaryngol 2008;265:331-335. https://doi.org/10.1007/s00405-007-0454-2