A randomized, clinical trial comparing butylcyanoacrylate with octylcyanoacrylate in the management of selected pediatric facial lacerations

Objective: To compare two tissue adhesives, butylcyanoacrylate and octylcya noacrylate, in the treatment of small (<4 cm) superficial linear traumatic facial lacerations in children. Methods: This was a randomized, clinical tr ial with parallel design. 94 children <18 years of age seen in the ED of a tertiary care pediatric hospital with a facial laceration suitable for tiss ue adhesive closure underwent laceration closure using either butylcyanoacr ylate or octylcyanoacrylate. The primary outcome was the cosmetic result at three months rated from photographs by a plastic surgeon on a visual analo g scale (VAS). Secondary outcomes included the time to perform the procedur e, the perceived difficulty of the procedure, the pain perceived by the pat ient, and a wound evaluation score at ten to 14 days and three months. Resu lts: Ninety-four patients were randomized with 47 in each group. The two gr oups were similar for baseline demographic and clinical characteristics. Th ere was no difference in the three-month cosmesis VAS (median, 70.0 mm for n-butyl-2-cyanoacrylate vs 67.5 mm for octylcyanocrylate, p = 0.84). There was no difference between the groups for time to complete the procedure (p = 0.88), parent/patient-perceived pain of the procedure (p = 0.37), or phys ician-perceived difficulty of the procedure (p = 0.33). Similarly, there wa s no difference between the groups for the percentage of early (p = 0.58) o r late (p = 0.71) optimal wound evaluation scores. Conclusions: In the clos ure of small linear pediatric facial lacerations, octylcyanoacrylate is sim ilar to butylcyanoacrylate in ease of use and early and late cosmetic outco mes. The superior physical properties of octylcyanoacrylate appear to add l ittle benefit to the management of these selected lacerations. Physician pr eference and differing costs may dictate use for these small selected lacer ations.