Structured clinical question

In children who have sustained a lip laceration extending through the vermilion border [patient], is tissue adhesive [intervention] better than sutures [comparison] at reducing procedural discomfort and improving cosmetic outcome [outcomes]?

Search strategy and outcome

Medline 1966 to August 2002 using the Ovid interface (exp lacerations or exp wounds, nonpenetrating or exp facial injuries or laceration$.mp or exp wounds and injuries or wound$.mp) and (exp lip or lip$.mp or vermilion$.mp) and (exp fibrin tissue adhesive or exp tissue adhesives or tissue adhesive$.mp or $cyanoacrylate$.mp or exp cyanoacrylates or wound glue$.mp or histoacryl.mp or exp wound healing or exp suture techniques) limit to human and English.

Altogether 292 papers were found, of which only one described the proposed intervention.¹ Three other papers were found comparing tissue adhesive to sutures in paediatric patients with facial lacerations, and these have also been included in table 1⇓.

Commentary

Traditional teaching has been that in lacerations involving the lip, the vermilion border must be accurately approximated with a suture to ensure that healing occurs without a step. A recent systematic review² has outlined the benefits of using tissue adhesive as an alternative method of wound closure to sutures, and three studies have specifically looked at a comparison between tissue adhesive and sutures in paediatric facial lacerations.^3–,⁵ These all compared tissue adhesive to sutures, and gave comparable cosmetic results with less time taken for the procedure and less pain for the child with tissue adhesive. However, lacerations of the lip were excluded from these trials. Although it is tempting to extrapolate these findings to other specific areas of wound management such as closure of lip lacerations, problems associated with this location could be anticipated, such as the child biting or licking off the glue. It should be borne in mind that there is a small but statistically significant increased rate of dehiscence with tissue adhesives compared to sutures.² There is only one published case report supporting tissue adhesive as a method of closure in these lacerations.