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In Search of an Ideal Closure Method: A Randomized, Controlled Trial of Octyl-2-Cyanoacrylate and Adhesive Mesh versus Subcuticular Suture in Reduction Mammaplasty

Lee, James C., M.D.; Ishtihar, Sherene, B.S.; Means, Jessica J., M.D.; Wu, June, M.D.; Rohde, Christine H., M.D., M.P.H.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 850–856
doi: 10.1097/PRS.0000000000004726
Breast: Original Articles

Background: An ideal wound closure system is one that is effective, consistent, and efficient. Recent studies have demonstrated the efficacy of octyl-2-cyanoacrylate and mesh (Dermabond Prineo) in the closure of surgical wounds. This study compared the use of Prineo to use of subcuticular suture closure in reduction mammaplasty.

Methods: A prospective, randomized, controlled, single-blind study of patients undergoing bilateral reduction mammaplasty was performed. Each breast per patient was randomized to layered closure with Prineo or subcuticular sutures. Incisions were assessed at 2 weeks, 6 weeks, 6 months, and 1 year. Subjects completed the Patient and Observer Scar Assessment Scale for each breast, and two blinded plastic surgeons evaluated scar quality using the Vancouver Scar Scale at each time point.

Results: Twenty-one patients participated in the study. On average, Prineo closure took 58.38 seconds (2.50 seconds/cm) and subcuticular closure took 444.76 seconds (18.94 seconds/cm). Prineo closure was approximately 6.8 times faster (p < 0.001) than subcuticular closure, saving an average of 6.4 minutes per incision. Vancouver Scar Scale scores were significantly better in patients with Prineo closure at 2 weeks (p = 0.026), although there was no difference in Patient and Observer Scar Assessment Scale and Vancouver Scar Scale scores at all other time points.

Conclusions: In reduction mammaplasty, Prineo closure results in similar scar quality and lower operative cost without increased complications when compared to subcuticular closure. Prineo is faster than subcuticular closure and represents an effective, consistent, and efficient alternative to subcuticular suture techniques.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

New York, N.Y.

From New York-Presbyterian Hospital/Columbia University Medical Center.

Received for publication October 31, 2017; accepted March 14, 2018.

Presented at Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 though 10, 2017, and awarded Best Resident Aesthetic Paper; and the 34th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Newport, Rhode Island, September 8 through 10, 2017.

Disclosure: This study was funded in part by an investigator-initiated research grant from Ethicon, Inc. None of the authors has other financial interests in any of the products or devices mentioned in this article. None of the authors has received consultancy or speaker fees from Ethicon, Inc., or its parent company, Johnson & Johnson.

Christine H. Rohde, M.D., M.P.H., Columbia University Medical Center, Herbert Irving Pavilion, Division of Plastic Surgery, 161 Fort Washington Avenue, 5th Floor, Room 511, New York, N.Y. 10032, chr2111@cumc.columbia.edu

©2018American Society of Plastic Surgeons