Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea

Purpose

This study was performed to evaluate the safety and feasibility of skin adhesives and to compare postoperative and cosmetic outcomes after wound closure in single-port laparoscopic appendectomy (SPLA) between skin adhesives and steri-strips.

Methods

This was a single-center retrospective study. We included 22 and 47 patients in whom skin adhesive and steri-strips were used respectively, for skin closure after subcuticular suturing in SPLA between August 2014 and 2020. The patient scar assessment questionnaire (PSAQ) was completed postoperatively to assess postoperative cosmetic outcomes.

Results

On the postoperative day, patients in whom skin adhesive was used had significantly lower numeric rating scores than in whom steri-strips were used (2.8 ± 0.8 vs. 3.9 ± 0.8, p < 0.001). The frequency of analgesic administration within 24 hours and between 24 and 48 hours after surgery was significantly lower in the skin adhesive group compared to the wound closure strip group (1.4 ± 0.8 vs. 2.7 ± 1.2, p = 0.013 and 0.2 ± 0.4 vs. 0.7 ± 0.9, p = 0.002, respectively). In the PSAQ, "satisfaction with appearance" and "satisfaction with symptoms" subitem scores were significantly lower in patients in whom skin adhesive was used (11.3 ± 3.0 vs. 15.1 ± 4.5, p = 0.006 and 6.5 ± 1.8 vs. 9.5 ± 3.3, p = 0.003), whereas, "appearance" and "consciousness" subitems revealed no statistically significant differences between the groups.

Conclusion

Liquid skin adhesive closures seem to be safe and feasible and cause less postoperative pain, resulting in greater patient satisfaction with postoperative scars than wound closure strip closure after subcuticular suturing in SPLA.

Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study

BACKGROUND

The skin in contact with the adhesives used to secure catheters is vulnerable to medical adhesive-related skin injury (MARSI). The incidence of these injuries and the risks associated with their development have not been accurately estimated previously in critically ill patients.

AIM

The aim of this study was to investigate the incidence and risk factors for MARSI in catheters of critically ill patients.

METHODS

A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. The skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral, and indwelling urinary) was examined daily by four trained researchers. The patients' sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by a multiple logistic regression.

RESULTS

The MARSI incidence was 42% (86.5 MARSIs per 1000 patient-days). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score, and hypoalbuminemia were associated with MARSI (p < .05). According to the multivariate logistic regression, dry skin increased the chance of MARSI by 5.2 times (odds ratio: 5.2; 95% confidence interval: 2.4-11.1), while the Braden Scale score was a protective factor, showing 30% less chance of MARSI for each added score (odds ratio: 0.7; 95% confidence interval: 0.6-0.9). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%), and tension injury or blister (2.9%).

CONCLUSIONS

MARSI is a common event in adult intensive care units, and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimising financial resources, and improving clinical results.

Skin tapes and tissue adhesive vs. either method alone for laceration repair in a porcine model

STUDY OBJECTIVE

To determine whether the combination of skin tapes and tissue adhesive is superior to either method alone for laceration repair.

METHODS

This was a prospective, longitudinal experiment on six anesthetized swine. Thirty-six full-thickness linear wounds were created using a metal template, then closed using one of three methods: skin tapes over benzoin, tissue adhesive, or a combination of both. The study was done in two parts. Group 1 (immediate excision) animals were euthanized at day zero for skin excision and tensile strength testing following wound repair. Group 2 (delayed excision) had initial wound repair; animals were euthanized at day 35 for skin excision and tensile strength testing.

RESULTS

In Group 1, the combination of skin tapes and tissue adhesive provided the strongest immediate wound closure. Average mean force for disruption immediately after wound repair was 19.9 lbs. for the tapes and tissue adhesive group compared to 9.6 lbs. for adhesive alone and 8.9 lbs. for tapes alone. The difference in mean force for combination repair vs. tapes alone was 10.3 lbs. (95% CI 4.1, 16.7), and combination vs. adhesive alone was 10.9 lbs. (95% CI 4.7, 17.3). In Group 2, the mean force required for laceration disruption for those repaired with both tape and tissue adhesive was 188.9 lbs. The mean force until wound disruption for tape only was 165.6 lbs., and the mean force until wound disruption for tissue adhesive alone was 118.9 lbs. The difference in mean force required for wound disruption for those repaired with adhesive alone vs. combination repair is 66.5 lbs. (95% CI 21.2, 111.9). The difference in mean force required for wound disruption between the other two groups was not statistically significant.

CONCLUSIONS

This study demonstrates that the combination of skin tapes and tissue adhesive provides superior immediate wound closure strength to either of these methods alone in a porcine model.

Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters

BACKGROUND

With over 2 billion peripheral intravenous catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective catheter dressing and securement is a key nursing strategy to reduce catheter failure and resultant patient harm.

OBJECTIVES

To describe global catheter dressing and securement practices and policy; and identify factors associated with catheter insertion site complications, and suboptimal dressing and securement.

DESIGN

Secondary analysis of a global cross-sectional study of peripheral intravenous catheter characteristics, management and outcomes.

SETTING

Four hundred and seven rural, regional and metropolitan hospitals in 51 countries.

PARTICIPANTS

Paediatric and adult patients with 40,637 catheters.

METHODS

Patient-, catheter-, and institution-related factors which could be associated with catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in catheter dressing and securement policy and practice were described. Potential predictors of catheter and dressing complications were explored using logistic regression.

RESULTS

Dressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50-0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59-0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22-2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51-1.75). Two 'bundled' dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1-3 days were associated with better catheter dressing integrity.

CONCLUSION

Modifiable risk factors for peripheral intravenous catheter site and dressing complications were identified and are amendable to further interventional testing.

The Usefulness of Leukosan SkinLink for Simple Facial Laceration Repair in the Emergency Department

Background

Repair of facial laceration in the emergency department can pose a number of difficulties. Children can be uncooperative, but adults can also be if they have sustained head trauma or are intoxicated. Leukosan SkinLink consists of topical adhesive and adhesive tape that can be applied easily to long or tense wounds. In this study, the authors compared conventional suturing with Leukosan SkinLink for facial laceration patients in the emergency department.

Methods

The prospective study was carried out from March 2013 to September 2013 with linear facial laceration patients visiting the emergency department. Exclusion criteria were open fractures, joint injuries, skin defects, hairy skin, and mucosa. The author used Leukosan SkinLink for skin closure in the experimental group and used conventional suturing in the control group. The scar evaluation using the Patient and Observer Scar Assessment Scale (POSAS) along with satisfaction scores, procedure times, and complications were compared.

Results

A total of 77 patients (30 in the control group and 47 in the experimental group) participated and underwent follow-up for 6 months postoperatively. The scar assessment using the POSAS and the satisfaction score in both groups were similar. The average procedure time in the experimental group was shorter. In the control group, there were four cases of wound dehiscence, two of infection, and one of skin necrosis, whereas four cases of wound dehiscence and one allergic reaction occurred in the experimental group.

Conclusions

With a simple application technique, Leukosan SkinLink is a new effective method for facial laceration repair especially useful for children and uncooperative adults.