Alternative Methods of Wound Closure

Alternative Methods of Wound Closure

Wound closure tapes

Wound closure tapes (eg, Steri-Strips) are composed of strips of reinforced microporous surgical adhesive tape. They are used to provide extra support to a suture line, either when running subcuticular sutures are used or after sutures are removed.
Wound closure tapes may reduce spreading of the scar if they are kept in place for several weeks after suture removal. Often, they are used in conjunction with a tissue adhesive. Because they have a tendency to fall off, they are used mainly in low-tension wounds and rarely for primary wound closure.

Staples

Stainless steel staples are frequently used in wounds under high tension, including wounds on the scalp or the trunk. Advantages of staples include quick placement, minimal tissue reaction, low risk of infection, and strong wound closure. Disadvantages include less precise wound edge alignment and higher cost.

Tissue adhesive

Superglues that contain acrylates may be applied to superficial wounds to block pinpoint skin hemorrhages and to precisely coapt wound edges. Because of their bacteriostatic effects and easy application, they have gained increasing popularity.^{[38, 39, 40, 41]}
Tissue adhesives have demonstrated either cosmetic equivalence or superiority to traditional sutures in various procedures, including sutureless closure of pediatric day surgeries, saphenous vein harvesting for coronary artery bypass, and blepharoplasty.^{[42] [43, 44]} The most commonly used adhesive, 2-octyl cyanoacrylate (Dermabond), has also been used as a skin bolster for suturing thin, atrophic skin.^[45]
Advantages of these topical adhesives include rapid wound closure, painless application, reduced risk of needle sticks, absence of suture marks, and elimination of any need for removal. Disadvantages include increased cost and less tensile strength (in comparison with sutures).
The use of tissue adhesives in dermatologic surgery is still evolving. It appears that using high viscosity 2-octyl cyanoacrylate in the repair of linear wounds after Mohs micrographic surgery results in cosmetic outcomes equivalent to those reported with the use of epidermal sutures.^[46]
Greenhill and O’Regan reported on the use of N-butyl 2-cyanoacrylate for closure of parotid wounds and its relation to keloid and hypertrophic scar formation, as compared with the use of sutures.^[47] Their results indicated a simpler technique and a comparable result with the tissue adhesive.
In a related area, Tsui and Gogolewski reported on the use of microporous biodegradable polyurethane membranes, which may be useful for coverage of skin wounds, among other things.^[48]

Barbed sutures

A barbed suture has been developed that is being evaluated for its efficacy in cutaneous surgery. The proposed advantage of such a suture is the avoidance of suture knots. Suture knots theoretically may be a nidus for infection, are tedious to place, may place ischemic demands on tissue, and may extrude following surgery.
A randomized controlled trial comparing a barbed suture with conventional closure using 3-0 polydioxanone suture suggests that a barbed suture has a safety and cosmesis profile similar to that of a conventional suture when used to close cesarean delivery wounds.^[49]
Barbed sutures have also been used in minimally invasive procedures to lift ptotic face and neck tissue. In one study, average patient satisfaction 11.5 months after a thread lift was 6.9/10.^[50] By 3 months after the procedure, the skin of the neck and jawline relaxed and the final results became apparent. Overall, the barbed suture lift was determined to provide sustained improvement in facial laxity.
These positive findings notwithstanding, painful dysesthesias and suture migration distant to the insertion site have been reported.^{[51, 52]} Although the long-term efficacy of barbed suspension sutures remains unclear, they may allow a minimally invasive facial lift with few adverse effects.^[53]

Novel punch biopsy closure

Placing sutures lateral to a punch biopsy causes the defect to taper, allowing a more linear closure and yielding improved cosmetic outcomes.^[54] A simple interrupted stitch is placed 1-3 mm lateral to a wound edge, a second stitch is placed 1-3 mm lateral to the opposite wound edge, and a final stitch is placed at the center of the wound. Sites larger than 4 mm may require additional interrupted stitches. Disadvantages include extended procedure time and increased risk of suture marks.