King's Foot and Ankle Unit, King's College NHS Foundation Trust, Orpington, UK.
Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
Foot Ankle Int. 2021 Sep;42(9):1106-1114. doi: 10.1177/10711007211002501. Epub 2021 Apr 19.
There are many options for incision closure in forefoot surgery. The aim of this study was to compare topical skin adhesive (2-octyl-cyanoacrylate) to simple interrupted nylon sutures.
A prospective randomized controlled trial comparing topical skin adhesive (TSA) and nylon sutures (NSs) for elective open forefoot surgery. Primary outcome was Hollander Wound Evaluation Scale (HWES) assessed 2 weeks following surgery. Secondary objectives included time taken for wound closure, wound assessment, patient satisfaction with wound cosmesis, incision pain, and infection rate.
Between January and December 2018, 84 feet (70 patients) underwent hallux valgus scarf/Akin osteotomy or first metatarsophalangeal arthrodesis and were randomized to receive either intervention (topical skin adhesive) or control (3/0 nylon sutures). We found worse HWES scores when using TSA compared to NSs (1.07 vs 0.60). Incision closure time was slower for TSA (mean, 272 vs 229 seconds). At 2 weeks postoperatively, wound care was faster for TSA (mean 71 secs) vs NSs (mean 120), and patient-reported pain was less with TSA (visual analog scale: TSA 1.2 vs NSs 2.1). A high degree of overall patient satisfaction was reported in both groups, without significant difference.
Closure of elective forefoot surgery incisions with topical skin adhesive or interrupted nylon sutures offers high satisfaction rates, low pain scores, and low complications. However, topical skin adhesive was associated with more inflammation and areas of wound separation compared to nylon sutures. We recommend the use of sutures for wound closure in forefoot surgery.
Level I, randomized controlled trial.
在足前部手术中，有许多切口闭合的选择。本研究的目的是比较局部皮肤粘合剂（2-辛基氰基丙烯酸酯）与简单间断尼龙缝线。
一项前瞻性随机对照试验比较了局部皮肤粘合剂（TSA）和尼龙缝线（NSs）在择期开放性足前部手术中的应用。主要结局是术后 2 周时使用 Hollander 伤口评估量表（HWES）评估。次要目标包括伤口闭合时间、伤口评估、患者对伤口美容效果的满意度、切口疼痛和感染率。
2018 年 1 月至 12 月期间，84 只脚（70 例患者）行拇外翻斜行截骨/阿金骨切开术或第一跖趾关节融合术，并随机接受局部皮肤粘合剂或对照（3/0 尼龙缝线）治疗。我们发现使用 TSA 时 HWES 评分比 NSs 差（1.07 比 0.60）。TSA 的切口闭合时间较慢（平均 272 比 229 秒）。术后 2 周时，TSA 的伤口护理更快（平均 71 秒），而 NSs 的伤口护理较慢（平均 120 秒），TSA 的患者报告疼痛较轻（视觉模拟评分：TSA 1.2 比 NSs 2.1）。两组患者均报告了较高的总体满意度，差异无统计学意义。
局部皮肤粘合剂或间断尼龙缝线闭合择期足前部手术切口可获得较高的满意度、较低的疼痛评分和较低的并发症发生率。然而，与尼龙缝线相比，局部皮肤粘合剂与更多的炎症和伤口分离区域相关。我们建议在足前部手术中使用缝线进行伤口闭合。
一级，随机对照试验。
