Fast Absorbing Gut Suture Versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery
Cyanoacrylate is a rapidly polymerizing topical adhesive commonly used as an alternative to
traditional sutures. Both cyanoacrylate and fast absorbing gut suture eliminate the need
for suture removal which can represent a significant savings in patient and staff time as
well as related healthcare resources. Both cyanoacrylate and fast absorbing gut suture are
currently routinely used for epidermal closure at Yale following Mohs micrographic surgery.
Physician preference currently dictates which epidermal closure method is chosen for a
Cyanoacrylate has been reported to decrease trauma to the epidermal edges, minimize suture
tract marks in surgical scars, and decrease the risk of inflammatory reaction to suture
material. Cyanoacrylate, however, does not allow for wound eversion.
Wound eversion minimizes the risk of a depressed scar from tissue contraction during
healing. As with all sutures, fast absorbing gut suture allows for wound eversion which is
reported to maximize the likelihood of a good epidermal approximation. On the other hand,
fast absorbing gut suture degrades by proteolysis which can result in an inflammatory
reaction. Any inflammatory reaction on the skin while healing can affect the final
cosmetic outcome (ie. post-inflammatory hyperpigmentation).
A recent article (Tierney 2009), reported that tissue adhesive may not be as effective in
achieving optimal cosmesis as fast absorbing gut for defects on the trunk and extremities.
However, we would like to study these two methods for the repair of facial wounds, which are
in low tension areas as compared to trunk and extremities. Therefore, it is unknown exactly
which of these two method is better than the other in epidermal closure of facial wounds
follow Mohs micrographic surgery.
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
Visual Analog Scale (VAS)
The Visual Analog or Analogue Scale (VAS)* is designed to present to the respondent a rating scale with minimum constraints. Respondents mark the location on the 10-centimeter line corresponding to their feeling. It also gives the maximum opportunity for each respondent to express a personal response style. The scale is interpreted as the greater the scale score (as the score approaches 10), the greater the cosmetic and functional outcome of the healed wound. Aitken, R. C. B. (1969). Measurement of feelings using visual analogue scales. Proceedings of the Royal Society of Medicine. 62, 989 - 993 Freyd, M. (1923). The graphic rating scale. Journal of Educational Psychology, 43, 83 - 102 Hayes, M. H. S. & D. G. Patterson (1921). Experimental development of the graphic rating method. Psychological Bulletin, 18, 98-99
David Leffell, MD
United States: Institutional Review Board
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