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Comparison of 2 Methods of Incision Closure in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery

Xu, Leilei PhD; Zhu, Feng MD; Zhu, Zezhang MD; Liu, Zhen MD; Sun, Xu MD; Qiao, Jun PhD; Mao, Saihu MD; Qiu, Yong MD

doi: 10.1097/BRS.0000000000000223
Randomized Trial

Study Design. A prospective, randomized, and controlled clinical trial.

Objective. To compare surgical zipper with subcuticular Monocryl sutures in terms of incision closure time, cosmetic results, and the complication rate in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) surgery.

Summary of Background Data. In previous literatures, the application of surgical zipper to incision closure has been reported to be associated with a favorable outcome. However, in the PSF surgery of patients with AIS, the use of surgical zipper has not been described.

Methods. Ninety female patients with AIS undergoing PSF were assigned randomly to 2 incision closure groups either using surgical zipper or using the 4-0 absorbable subcuticular suture. The incision outcome was evaluated with the Hollander Incision Evaluation Score at 7 days, 2 weeks, 6 months, and 1 year after surgery, respectively. Besides, a visual analogue scale was allocated to each patient to rate the cosmetic result of the incision. The 2 groups were compared to determine the differences in terms of incision closure time, the complication rate, and cosmetic results.

Results. The incision closure using surgical zipper consumed significantly less time than that using subcuticular suture (45.3 vs. 540.5 s, P < 0.001). As for the cosmetic results, no significant differences of Hollander Incision Evaluation Score scores between the 2 suturing groups were found. Besides, patients’ satisfaction with cosmetic outcome on a linear visual analogue scale also revealed similar results between the 2 groups. As for postoperative complications, we found 1 case of mild blister due to allergy to the tape of the dressings and 2 cases of incisional pain in the Monocryl suture group.

Conclusion. The application of surgical zipper in PSF surgery is a safe and effective method. The ease and the speed of application make surgical zipper an attractive option for incision closure in patients with AIS undergoing PSF.

Level of Evidence: 4

Using surgical zipper could bring about good clinical and cosmetic results comparable with those of subcuticular Monocryl sutures. Meanwhile, surgical zipper consumes much less time than traditional methods for incision closure. The ease and the speed of application make surgical zipper an attractive alternative for incision closure of adolescent idiopathic scoliosis.

From The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.

Address correspondence and reprint requests to Yong Qiu, MD, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Rd 321, Nanjing 210008, China; E-mail:

Acknowledgment date: July 26, 2013. Revision date: November 27, 2013. Acceptance date: January 9, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Public Health Benefit Research Foundation, China (grant no. 201002018) funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins