Fontana Sonja, Schiestl Clemens M, Landolt Markus A, Staubli Georg, von Salis Sara, Neuhaus Kathrin, Mohr Christoph, Elrod Julia
Department of Pediatric Emergency Medicine, University Children's Hospital Zurich, Zurich, Switzerland.
Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland.
Front Pediatr. 2021 Feb 12;8:616151. doi: 10.3389/fped.2020.616151. eCollection 2020.
Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications. In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6-12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed. A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97-2.25] vs. 2.5, 95% CI [2.39-2.63]; < 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981-1.34] vs. 1.6, 95% CI [1.49-1.79], < 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 ( < 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1. Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately. Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).
尽管皮肤粘合剂已被用于治疗皮肤裂伤数十年，但长期效果和并发症仍存在不确定性。在这项前瞻性、对照、单盲观察性队列研究中，由五位整形外科医生在6至12个月时使用改良的患者和观察者瘢痕评估量表（POSAS）和温哥华瘢痕量表（VSS）通过标准化照片评估结果；此外，POSAS由患者/护理人员和医生进行评估；评估疼痛、麻醉需求、治疗时间、成本、并发症和生活质量（QoL）。共纳入367例患者；230例纳入主要分析；96处伤口使用组织粘合剂闭合（第1组）；134处伤口进行缝合（第2组）。独立观察者的评估显示，与第2组相比，第1组的平均改良总体POSAS评分有所改善[2.1，95%可信区间[1.97 - 2.25]对2.5，95%可信区间[2.39 - 2.63]；P < 0.001，d = 0.58]，平均VSS评分也有所改善[1.2，95%可信区间[0.981 - 1.34]对1.6，95%可信区间[1.49 - 1.79]，P < 0.001，d = 0.53]。在早期随访时，第1组的裂开率为12.5%，第2组为3.7%（P < 0.001）；后来，每组各有1例裂开。两组在早期随访时均发现生活质量有轻度损害，后期无损害残留。第1组的治疗持续时间和治疗成本较低。两种伤口闭合方式均产生良好的美学效果，且并发症罕见。粘合剂更具成本效益，且应用耗时更少；因此，组织粘合剂在适当使用时具有相当大的优势。在www.ClinicalTrials.gov进行了公共试验注册（标识符：NCT03080467）。
