A Prospective Controlled Study on Long-Term Outcomes of Facial Lacerations in Children

Abstract

Background: Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications. Methods: In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6-12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed. Results: A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97-2.25] vs. 2.5, 95% CI [2.39-2.63]; p < 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981-1.34] vs. 1.6, 95% CI [1.49-1.79], p < 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p < 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1. Conclusion: Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately. Trial Registration: Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).

Keywords: POSAS; VSS; blinded; glue; outcome; pediatrics; scar; suture.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Fontana, Schiestl, Landolt, Staubli, von Salis, Neuhaus, Mohr and Elrod.

Figures

Figure 1

Mean Observer score of the Patient and Observer Scar Assessment Scale (POSAS) at late follow-up (at 6–12 months). Results are depicted separately by treatment group (blue = group 1, tissue adhesive; red = group 2, suture) for each of the POSAS items and for the POSAS Overall score; and significance levels are indicated. Significance levels are indicated (*p < 0.05, **p < 0.01, ***p < 0.001).

Figure 2

Results of the online evaluation of 230 scars by independent surgeons for mean modified Observer score of the Patient and Observer Scar Assessment Scale (POSAS) are illustrated separately by treatment group (blue = group 1, tissue adhesive, red = group 2, suture). Significance levels are indicated. Significance levels are indicated (*p < 0.05, **p < 0.01, ***p < 0.001).

Figure 3

Mean modified total score of the Patient and Observer Scar Assessment Scale (POSAS) shown separately for each of the 230 scars by online evaluation. The mean modified POSAS Total score as evaluated by the five independent, blinded specialists in plastic surgery is shown separately for each of the 230 scars. Results are illustrated by treatment group (blue = group 1, tissue adhesive, red = group 2, suture).

Figure 4

Results of the online evaluation of 230 scars by independent surgeons for mean modified Vancouver Scar Scale Scores are illustrated separately by treatment group (blue = group 1, tissue adhesive, red = group 2, suture). Significance levels are indicated. Significance levels are indicated (**p < 0.01, ***p < 0.001).

Figure 5

Exemplary range of photographs scored with the POSAS. This is a compilation of four photographs of facial lacerations, scored by one of the online observers using the POSAS and merely serves for a better illustration [POSAS Observer scale, overall opinion = (a) 1, (b) 3, (c) 5, and (d) 7].