A Randomized Controlled Trial Comparison of Subcuticular Suture and Adhesive Strip for Cosmetic Outcome in Median Sternotomy Closure in Patient Undergoing Cardiac Surgery.

BACKGROUND

The median sternotomy incision is a common approach in cardiac surgery, often leading to noticeable scar formation that can impact patients' quality of life. This study aims to compare outcomes between subcuticular suture and adhesive strip (Steri-stripTM, 3M HealthCare®) closure techniques for median sternotomy incisions in cardiac surgery patients.

METHODS

In this prospective randomized controlled trial, 112 patients undergoing cardiac surgery (August 2020 to September 2021) were assigned to either the adhesive strip or subcuticular suture group. Wound assessments occurred on postoperative days 3, 7, and before discharge, monitoring for infection and dehiscence. Follow-ups at 1-2 weeks, 3 months, and 6 months used scar scales, including Vancouver Scar Scale (VSS), Manchester Scar Scale (MSS), and Patient and Observer Scar Assessment Scale (POSAS).

RESULTS

Out of a total of 112 patients, 6 were excluded. All remaining patients were completely followed up. No significant differences were observed in VSS, MSS, POSAS outcomes, or wound complications during postoperative follow-ups. Adhesive strip closure took 0.49 minutes, significantly less than 7.27 minutes for subcuticular sutures (P < 0.001). Furthermore, the total cost of adhesive strips was lower than the subcuticular suture group.

CONCLUSION

The adhesive strips application for skin closure of median sternotomy wounds was found to be non-inferior to subcuticular sutures in terms of clinical outcomes and postoperative wound complications. Additionally, this approach resulted in reduced operative time and proved to be cost-effective in hospital care.

LEVEL OF EVIDENCE I

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