Aesthetic comparison of wound closure techniques in a porcine model

Objective: To compare various commonly used closure techniques and their es thetic results. Also to look for differences in cost, time, and ease of use among the methods. Design: A prospective comparison in a porcine skin mode l with a blinded assessment of outcomes. Methods: Thirty 6-cm, full-thickne ss skin incisions were made on the back of two domestic white swine. Underm ining was accomplished, and buried simple, interrupted, absorbable, braided (Polysorb, US Surgical) subdermal sutures were placed in a uniform fashion in each wound. The skin was then closed using one of the following five me thods: running subcuticular 4-0 nylon, running subcuticular 4-0 absorbable monofilament (Biosyn, US Surgical), tissue glue (Dermabond, Ethicon), adhes ive tape, or running subcuticular nylon with intradermal injection of hyalu ronic acid. Nonabsorbable sutures and tape were removed on postoperative da y 7, and photographs were taken at regular intervals during a 12-week heali ng period. Biopsies were taken from wounds in each group at 2 weeks and 12 weeks for histologic comparison. Independent observers evaluated the photog raphs, and an independent histologist evaluated the biopsies to look for di fferences in inflammation and scar formation. The surgeons who performed th e wound closure rated the ease of use and amount of time required for each technique. Results: Adhesive tape closure was faster and easier to perform. There were no significant differences among the adhesive tape, nylon, or a bsorbable suture groups regarding cosmetic appearance throughout the study period. The tissue glue wounds had more of a tendency to dehisce. Adhesive tape is less expensive than the other methods when material costs and opera ting room time are considered. Conclusion: Adhesive tape closure of surgica l wounds is cosmetically acceptable, convenient, and saves both time and ma terial costs. We recommend it as an alternative for closure of neck incisio ns.