Tissue adhesives for closure of surgical incisions

Jo C Dumville; Paul Coulthard; Helen V Worthington; Philip Riley; Neil Patel; James Darcey; Marco Esposito; Maarten van der Elst; Oscar J F van Waes

doi:10.1002/14651858.CD004287.pub4

Cochrane Database of Systematic Reviews

Adhesivos tisulares para el cierre de las incisiones quirúrgicas

Información

DOI:

https://doi.org/10.1002/14651858.CD004287.pub4 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

28 noviembre 2014see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Heridas

Copyright:

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

Jo C Dumville

Correspondencia a: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

[email protected]
Paul Coulthard

Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Manchester, UK
Helen V Worthington

Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
Philip Riley

Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
Neil Patel

Oral Surgery, University Dental Hospital of Manchester, Manchester, UK
James Darcey

Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Manchester, UK
Marco Esposito

Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
Maarten van der Elst

Department of Surgery, Reinier de Graaf Groep, Delft, Netherlands
Oscar J F van Waes

Department of Surgery, Reinier de Graaf Groep, Delft, Netherlands

Contributions of authors

Jo Dumville: coordinated the second review update. Extracted data and checked quality of data extraction. Undertook and checked quality assessment. Analysed and interpreted data. Performed statistical analysis and checked quality of statistical analysis. Performed part of writing and editing the review. Approved final review update prior to submission. Secured funding. Is the guarantor of the review.
Paul Coulthard: conceived, designed and co‐ordinated the initial review. Undertook the searches for the original review and screened search results. Appraised quality and extracted data, wrote to trial authors for additional information. Managed data for the review and entered data into RevMan. Analysed and interpreted data and wrote the review. Undertook previous work that was the foundation of the current review. Approved final review update prior to submission.
Philip Riley: analysed and interpreted data for the second review update. Performed statistical analysis and checked quality of statistical analysis. Performed part of writing and editing the review. Approved final review update prior to submission.
Helen Worthington: analysed and interpreted data for all versions of the review. Performed statistical analysis and checked quality of statistical analysis. Performed part of writing and editing the review. screened search output for the second update. Approved final review update prior to submission
Neil Patel: undertook quality assessment and checked quality assessment for the first update. Performed part of writing and editing the review. Approved final review update prior to submission.
Marco Esposito: developed the search strategy, undertook the searches for the original review and advised on the review and commented on all updates of the review.
Maarten van der Elst: Provided general advice on the original version of the review and undertook previous work that was the foundation of the current review.
Oscar JF van Waes: screened search results against the inclusion criteria and retrieved papers, appraised quality and extracted data, wrote to trial authors for additional information for the original version of the review. Undertook previous work that was the foundation of the current review.
James Darcey: screened search results against the inclusion criteria, retrieved papers, appraised quality and extracted data, wrote to trial authors for additional information for the for the first review update, managed data for the first review update and entered data into RevMan. Analysed and interpreted data and wrote the first review update.

Contributions of editorial base

Nicky Cullum: edited the review, advised on methodology, interpretation and review content. Approved the final review and review update prior to submission.
Sally Bell‐Syer: co‐ordinated the editorial process. Advised on methodology, interpretation and content. Edited and copy edited the review and the updated review.
Amanda Briant: ran the searches and edited the search methods section for the update.

Sources of support

Internal sources

The University of Manchester, UK.
Renier de Graaf Hospital, Netherlands.
The Sahlgrenska Academy at Goteborg University, Sweden.

External sources

Swedish Medical Research Council (9495), Sweden.
The Hjalmar Svensson Research Fund, Sweden.
The National Institute for Health Research (NIHR) is the sole funder of the Cochrane Wounds Group, UK.

Declarations of interest

Jo C Dumville: None known
Paul Coulthard: was a co‐author in the Blondeel 2004 study. This study was also commercially supported by Ethicon.
Philip Riley: None known
Helen V Worthington: None known
Neil Patel: None known
Marco Esposito: None known
Maarten van der Elst: None known
Oscar J F van Waes: None known
James Darcey: None known

Acknowledgements

We wish to thank Sally Bell‐Syer and Ruth Foxlee (Cochrane Wounds Group) for their assistance with literature searching the preparation of this review. We would also like to thank the following referees: Nicky Cullum, David Margolis, Michelle Briggs, Seokyung Hahn, James V Quinn, Ken Farion and Jac Dinnes. We also thank Matthew Fortnam who extracted data and checked quality of data extraction for this second review update.

Version history

Published

Title

Stage

Authors

Version

2014 Nov 28

Tissue adhesives for closure of surgical incisions

Review

Jo C Dumville, Paul Coulthard, Helen V Worthington, Philip Riley, Neil Patel, James Darcey, Marco Esposito, Maarten van der Elst, Oscar J F van Waes

https://doi.org/10.1002/14651858.CD004287.pub4

2010 May 12

Tissue adhesives for closure of surgical incisions

Review

Paul Coulthard, Marco Esposito, Helen V Worthington, Maarten van der Elst, Oscar J F van Waes, James Darcey

https://doi.org/10.1002/14651858.CD004287.pub3

2002 Jul 22

Tissue adhesives for closure of surgical incisions

Review

Paul Coulthard, Marco Esposito, Helen V Worthington, Maarten van der Elst, Oscar J F van Waes, James Darcey

https://doi.org/10.1002/14651858.CD004287.pub2

2002 May 16

Tissue adhesives for closure of surgical incisions

Protocol

Paul Coulthard, Helen V Worthington, Marco Esposito, Maarten van der Elst, F van Waes OJ, Oscar J F van Waes

https://doi.org/10.1002/14651858.CD004287

Differences between protocol and review

Time to closure as an outcome measure was included in the review post hoc as the review authors believe this to be a contributory factor towards both cost‐effectiveness and satisfaction.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Adhesive versus suture, Outcome 1 Dehiscence: all studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Adhesive versus suture, Outcome 2 Dehiscence: sensitivity analysis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Adhesive versus suture, Outcome 3 Infection: all studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Adhesive versus suture, Outcome 4 Infection: sensitivity analysis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Adhesive versus suture, Outcome 5 Cosmetic appearance rated by patient.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Adhesive versus suture, Outcome 6 Cosmetic appearance rated by surgeon.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Adhesive versus suture, Outcome 7 Patient/parent satisfaction (% satisfied).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Adhesive versus suture, Outcome 8 Patient/parent satisfaction (VAS Scale 0 to 100).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 Adhesive versus suture, Outcome 9 Surgeon satisfaction (% satisfied).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1 Adhesive versus suture, Outcome 10 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Adhesive versus adhesive tape, Outcome 1 Dehiscence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Adhesive versus adhesive tape, Outcome 2 Infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Adhesive versus adhesive tape, Outcome 3 Cosmetic appearance rated by patient (VAS).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Adhesive versus adhesive tape, Outcome 4 Cosmetic appearance rated by patient (% satisfied).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 Adhesive versus adhesive tape, Outcome 5 Cosmetic appearance rated by surgeon (VAS).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 Adhesive versus adhesive tape, Outcome 6 Patient satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

Comparison 2 Adhesive versus adhesive tape, Outcome 7 Surgeon satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

Comparison 2 Adhesive versus adhesive tape, Outcome 8 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Adhesive versus staples, Outcome 1 Dehiscence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Adhesive versus staples, Outcome 2 Infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Adhesive versus staples, Outcome 3 Cosmetic appearance rated by patient (scar scale).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3 Adhesive versus staples, Outcome 4 Cosmetic appearance by plastic surgeons (VAS).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3 Adhesive versus staples, Outcome 5 Patient satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

Comparison 3 Adhesive versus staples, Outcome 6 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4 Adhesive versus other method, Outcome 1 Dehiscence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4 Adhesive versus other method, Outcome 2 Infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4 Adhesive versus other method, Outcome 3 Patient satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4 Adhesive versus other method, Outcome 4 Clinician satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4 Adhesive versus other method, Outcome 5 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 1 Dehiscence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.2

Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 2 Infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.3

Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 3 Patient satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.4

Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 4 Clinician satisfaction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.5

Comparison 5 Adhesive versus adhesive: High viscosity versus low viscosity, Outcome 5 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 1 Dehiscence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.2

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 2 Infection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.3

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 3 Cosmetic assessment rated by patient (VAS).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.4

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 4 Cosmetic assessment rated by surgeon (VAS).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.5

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 5 Surgeon satisfaction (with device).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.6

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 6 Surgeon satisfaction (with closure).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.7

Comparison 6 Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate, Outcome 7 Time taken for wound closure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Tissue adhesive compared to sutures for surgical incisions

Tissue adhesive compared to sutures for surgical incisions
Patient or population: People with surgical incisions Settings: Intervention: Tissue adhesive Comparison: Sutures
Outcomes	*Illustrative comparative risks⁴ (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Sutures	Tissue adhesive
Wound dehiscence	Study population		RR 3.35 (1.53 to 7.32)	736 (10 studies)	⊕⊕⊝⊝ low^1,2
	13 per 1000	45 per 1000 (21 to 99)
	Moderate

Wound infection	Study population		RR 1.72 (0.92 to 3.16)	744 10 studies	⊕⊝⊝⊝ very low^2,3
	38 per 1000	76 per 1000 (14 to 397)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ Possible unit of analyses issues. A sensitivity analysis changes a statistically significant difference to a non‐statistically significant difference ² Study 95% CIs are wide ³ Possible unit of analysis issues ⁴ Median control (suture) group risk across studies

Summary of findings for the main comparison. Tissue adhesive compared to sutures for surgical incisions

Ir a la tabla de la revisión

Summary of findings 2. Tissue adhesive compared to adhesive tape for surgical incisions

Tissue adhesive compared to adhesive tape for surgical incisions
Patient or population: people with surgical incisions Settings: Intervention: tissue adhesive Comparison: adhesive tape
Outcomes	*Illustrative comparative risks³ (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Adhesive tape	Tissue adhesive
Wound dehiscence	Study population		RR 0.96 (0.06 to 14.55)	50 (1 study)	⊕⊕⊝⊝ low¹
	42 per 1000	40 per 1000 (2 to 606)
	Moderate

Wound infection	Study population		RR 1.37 (0.39 to 4.81)	190 (3 studies)	⊕⊕⊝⊝ low^1,2
	43 per 1000	60 per 1000 (17 to 209)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ Study 95% CIs are very wide ² Evidence of inconsistency in point estimates. With the point estimate from one study lying outside the 95% CIs of another ³ Control (tape) group risk in included study

Summary of findings 2. Tissue adhesive compared to adhesive tape for surgical incisions

Ir a la tabla de la revisión

Summary of findings 3. Tissue adhesive compared to staples for surgical incisions

Tissue adhesive compared to staples for surgical incisions
Patient or population: people with surgical incisions Settings: Intervention: tissue adhesive Comparison: staples
Outcomes	*Illustrative comparative risks³ (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Staples	Tissue adhesive
Wound dehiscence	Study population		RR 0.53 (0.05 to 5.33)	37 (1 study)	⊕⊕⊝⊝ low¹
	105 per 1000	56 per 1000 (5 to 561)
	Moderate

Wound infection	Study population		RR 1.39 (0.3 to 6.54)	250 (3 studies)	⊕⊝⊝⊝ very low^1,2
	71 per 1000	99 per 1000 (21 to 463)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Study 95% CIs are very wide. ² Evidence of point estimates lying in opposite directions with the estimate for one study lying outside the 95% CI of another. ³ Control (staples ) group risk for included study.

Summary of findings 3. Tissue adhesive compared to staples for surgical incisions

Ir a la tabla de la revisión

Summary of findings 4. Tissue adhesive compared to other methods for surgical incisions

Tissue adhesive compared to other methods for surgical incisions
Patient or population: people with surgical incisions Settings: Intervention: tissue adhesive Comparison: other methods
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Other methods	Tissue adhesive
Wound dehiscence	Study population		RR 0.55 (0.13 to 2.38)	209 (1 study)	⊕⊕⊝⊝ low^1,2
	49 per 1000	27 per 1000 (6 to 117)
	Moderate

Wound infection	Study population		RR 0.41 (0.11 to 1.6)	209 (1 study)	⊕⊕⊝⊝ low^1,2
	66 per 1000	27 per 1000 (7 to 105)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ Study 95% CIs are very wide ² Single study with low event rate

Summary of findings 4. Tissue adhesive compared to other methods for surgical incisions

Ir a la tabla de la revisión

Summary of findings 5. High viscosity tissue adhesive compared to low viscosity tissue adhesive for surgical incisions

High viscosity tissue adhesive compared to low viscosity tissue adhesive for surgical incisions
Patient or population: people with surgical incisions Settings: Intervention: high viscosity tissue adhesive Comparison: low viscosity tissue adhesive
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Low viscosity tissue adhesive	High viscosity tissue adhesive
Wound dehiscence	Study population		RR 3.74 (0.21 to 67.93)	148 (1 study)	⊕⊝⊝⊝ very low^1,2
	Could not be calculated	Could not be calculated


Wound infection	Study population		RR 0.82 (0.16 to 4.31)	148 (1 study)	⊕⊝⊝⊝ very low^1,2
	47 per 1000	38 per 1000 (7 to 200)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ Study 95% CIs are very wide ² Single study with low event rate

Summary of findings 5. High viscosity tissue adhesive compared to low viscosity tissue adhesive for surgical incisions

Ir a la tabla de la revisión

Summary of findings 6. Octylcyanoacrylate compared to butylcyanoacrylate for surgical incisions

Octylcyanoacrylate compared to butylcyanoacrylate for surgical incisions
Patient or population: people with surgical incisions Settings: Intervention: octylcyanoacrylate Comparison: butylcyanoacrylate
Outcomes	*Illustrative comparative risks² (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Butylcyanoacrylate	Octylcyanoacrylate
Wound dehiscence	26 per 1000	38 per 1000 (5 to 297)	RR 1.46 (0.19 to 11)	80 (2 studies)	⊕⊕⊝⊝ low¹
Wound infection	Study population		RR 0.63 (0.21 to 1.88)	37 (1 study)	⊕⊕⊝⊝ low¹
	333 per 1000	210 per 1000 (70 to 627)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ The 95% CI estimate around the RR of 1.46 is very wide ² Median control group risk across studies

Summary of findings 6. Octylcyanoacrylate compared to butylcyanoacrylate for surgical incisions

Ir a la tabla de la revisión

Table 1. Summary of study comparisons

Tissue adhesive vs tissue adhesive

(Comp 5)

Mixed control

(Comp 4)

Butyl‐2‐

cyanoacrylate

vs staples

(Comp 3)

2‐octyl

cyanoacrylate

vs staples

(Comp 3)

2‐octyl

cyanoacrylate

vs tape

(Comp 2)

Butyl‐2‐

cyanoacrylate

vs sutures

(Comp 1)

2‐octyl

cyanoacrylate

vs sutures

(Comp1)

Trial ID

2‐octyl

cyanoacrylate

Butyl‐2‐

cyanoacrylate

Sutures

Staples

Adhesive tape/strips

Mixed sutures and staples

All non‐tissue adhesive closure methods

Other viscosity 2‐octyl

cyanoacrylate

3

Amin 2009

✓

1

Avsar 2009

✓

5

4

Blondeel 2004

✓

1

Brown 2009

✓

1

Cheng 1997

✓

4

Chibbaro 2009

✓

1

Dowson 2006

✓

5

3

1

Eggers 2011

✓

1

Greene 1999

✓

1

Jallali 2004

✓

1

Keng 1989

✓

5

Kent 2014

✓

3

1

Khan 2006

✓

1

Kouba 2011

✓

1

Krishnamoorthy 2009

✓

3

Livesey 2009

✓

2

1

Maartense 2002

✓

5

Maloney 2013

✓

1

Millan 2011

✓

1

Mota 2009

✓

1

Ong 2002

✓

1

Ozturan 2001

✓

3

Pronio 2011

✓

3

Ridgway 2007

✓

1

Sebesta 2004

✓

2

1

Shamiyeh 2001

✓

1

Sinha 2001

✓

1

Sniezek 2007

✓

1

Switzer 2003

✓

1

Tierny 2009

✓

1

Toriumi 1998

✓

2

Romero 2011

✓

1

van den Ende 2004

✓

Abbreviation

Comp = comparison

Table 1. Summary of study comparisons

Ir a la tabla de la revisión

Comparison 1. Adhesive versus suture

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence: all studies Show forest plot	17	1225	Risk Ratio (M‐H, Random, 95% CI)	3.35 [1.53, 7.33]

2 Dehiscence: sensitivity analysis Show forest plot	13	935	Risk Ratio (M‐H, Random, 95% CI)	2.70 [0.95, 7.68]

3 Infection: all studies Show forest plot	18	1239	Risk Ratio (M‐H, Random, 95% CI)	1.72 [0.94, 3.16]

4 Infection: sensitivity analysis Show forest plot	15	977	Risk Ratio (M‐H, Random, 95% CI)	2.03 [0.80, 5.12]

5 Cosmetic appearance rated by patient Show forest plot	2	199	Mean Difference (IV, Random, 95% CI)	‐2.12 [‐7.20, 2.95]

5.1 VAS 0 to 100	2	199	Mean Difference (IV, Random, 95% CI)	‐2.12 [‐7.20, 2.95]
6 Cosmetic appearance rated by surgeon Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6.1 VAS scale 0 to 100	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 Scar assessment (0 to 5 scale)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Patient/parent satisfaction (% satisfied) Show forest plot	2	206	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.96, 1.07]

8 Patient/parent satisfaction (VAS Scale 0 to 100) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9 Surgeon satisfaction (% satisfied) Show forest plot	2	150	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.58, 2.19]

10 Time taken for wound closure Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

Comparison 1. Adhesive versus suture

Ir a la tabla de la revisión

Comparison 2. Adhesive versus adhesive tape

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2 Infection Show forest plot	3	190	Risk Ratio (M‐H, Random, 95% CI)	1.37 [0.39, 4.81]

3 Cosmetic appearance rated by patient (VAS) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Cosmetic appearance rated by patient (% satisfied) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5 Cosmetic appearance rated by surgeon (VAS) Show forest plot	2	139	Mean Difference (IV, Random, 95% CI)	9.56 [4.74, 14.37]

6 Patient satisfaction Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7 Surgeon satisfaction Show forest plot	2	141	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.63, 1.19]

8 Time taken for wound closure Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 2. Adhesive versus adhesive tape

Ir a la tabla de la revisión

Comparison 3. Adhesive versus staples

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence Show forest plot	2	107	Risk Ratio (M‐H, Random, 95% CI)	0.53 [0.05, 5.33]

2 Infection Show forest plot	4	320	Risk Ratio (M‐H, Random, 95% CI)	1.39 [0.30, 6.54]

3 Cosmetic appearance rated by patient (scar scale) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Cosmetic appearance by plastic surgeons (VAS) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5 Patient satisfaction Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6 Time taken for wound closure Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 3. Adhesive versus staples

Ir a la tabla de la revisión

Comparison 4. Adhesive versus other method

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence Show forest plot	2	249	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.13, 2.38]

2 Infection Show forest plot	2	249	Risk Ratio (M‐H, Random, 95% CI)	0.41 [0.11, 1.60]

3 Patient satisfaction Show forest plot	1	187	Mean Difference (IV, Fixed, 95% CI)	0.40 [0.10, 0.70]

4 Clinician satisfaction Show forest plot	1	209	Mean Difference (IV, Fixed, 95% CI)	0.53 [0.29, 0.77]

5 Time taken for wound closure Show forest plot	1	209	Mean Difference (IV, Fixed, 95% CI)	‐1.05 [‐1.79, ‐0.31]

Comparison 4. Adhesive versus other method

Ir a la tabla de la revisión

Comparison 5. Adhesive versus adhesive: High viscosity versus low viscosity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2 Infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3 Patient satisfaction Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Clinician satisfaction Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5 Time taken for wound closure Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 5. Adhesive versus adhesive: High viscosity versus low viscosity

Ir a la tabla de la revisión

Comparison 6. Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dehiscence Show forest plot	2	80	Risk Ratio (M‐H, Random, 95% CI)	1.46 [0.19, 11.30]

2 Infection Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3 Cosmetic assessment rated by patient (VAS) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4 Cosmetic assessment rated by surgeon (VAS) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5 Surgeon satisfaction (with device) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6 Surgeon satisfaction (with closure) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7 Time taken for wound closure Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 6. Adhesive versus adhesive: octylcyanoacrylate versus butylcyanoacrylate

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet

Scolaris Content Display Scolaris Content Display

Adhesivos tisulares para el cierre de las incisiones quirúrgicas

Información

Cifras del artículo

Altmetric:

Citado por:

Autores

Contributions of authors

Contributions of editorial base

Sources of support

Internal sources

External sources

Declarations of interest

Acknowledgements

Version history

Differences between protocol and review

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

PICO

PICO

Population

Intervention

Comparison

Outcome

Scolaris Language Selector Scolaris Language Selector

Scolaris Content Display Scolaris Content Display

Instituciones a las que se accedió previamente

Scolaris Content Display Scolaris Content Display

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Información

Cifras del artículo

Altmetric:

Citado por:

Autores

Contributions of authors

Contributions of editorial base

Sources of support

Internal sources

External sources

Declarations of interest

Acknowledgements

Version history

Differences between protocol and review

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

PICO

PICO

Population

Intervention

Comparison

Outcome

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso