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A Comparison of a New Skin Closure Device and Intradermal Sutures in the Closure of Full-Thickness Surgical Incisions

Richter, Dirk M.D.; Stoff, Alexander M.D.; Ramakrishnan, Venkat M.D.; Exner, Klaus M.D.; Jernbeck, Jan M.D.; Blondeel, Phillip N. M.D., Ph.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 843–850
doi: 10.1097/PRS.0b013e318262f237
Reconstructive: Trunk: Original Articles
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Background: A novel topical skin adhesive system was developed to close the outermost layer of skin in an expeditious manner. To determine its clinical utility, a clinical investigation was undertaken to demonstrate equivalence of a new adhesive skin closure system (Prineo Skin Closure System) to intradermal sutures in wound closure.

Methods: The investigation included 83 patients who underwent elective abdominoplasty, circumferential body lift procedures, and breast reconstruction with deep inferior epigastric perforator flaps. Incisions were divided in half, and each half was randomized to wound closure with the new skin closure system, including a pressure-sensitive adhesive mesh tape for wound edge approximation and next-generation cyanoacrylate or intradermal sutures. Postoperative evaluations took place at 24 hours, 7 days, 12 to 25 days, 90 days, 6 months, and 12 months.

Results: The new skin closure system was found to be equivalent to intradermal sutures for the continuous approximation of wounds. The upper limit of the two-sided 90 percent confidence interval for difference in proportions was 10.9 percent. The mean time to closure for the new skin closure system was 1.46 minutes, approximately 5 minutes faster than that for intradermal sutures (p < 0.0001). Both treatments had similar incision healing and cosmetic outcomes. No quantitative or qualitative differences of clinical significance were evident between the treatment groups.

Conclusions: The Prineo Skin Closure System can be considered equivalent to intradermal sutures for full-thickness surgical incisions with regard to safety and effectiveness. The ease and speed of application contribute to shortened operative times (4.5 times faster than intradermal sutures).

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Wesseling and Frankfurt-am-Main, Germany; Essex, United Kingdom; Stockholm, Sweden; and Ghent, Belgium

From Dreifaltigkeits-Hospital; St. Andrews Center for Plastic Surgery and Burns, Mid Essex Hospital NHS Trust; Markus Krankenhaus; Akademikliniken; and University Hospital Ghent.

Received for publication April 15, 2012; accepted April 30, 2012.

Disclosure:The multicenter study was sponsored by Ethicon, Inc. (formerly by the Closure Medical Corporation). Other than their participation in this clinical study, none of the authors has a financial interest in any of the products or devices mentioned in this article.

Phillip N. Blondeel, M.D., Ph.D., University Hospital Gent, De Pintelaan 185, 2K12C, B-9000 Gent, Belgium E-mail phillip.blondeel@ugent.be

©2012American Society of Plastic Surgeons