The Effect Of The Dermabond To The Long-term Outcomes Of The Surgical Incisions

BackgroundThe scar of the surgical incisions is always concerning the plastic surgeons and patients.In our clinical practice,we usually recommend the patients to use the silicon products or surgical strips to alleviate the scar formation.But we often observe that the silicon applications do not achieve good outcomes in the body regions where the skin tension is big,which means the scar will still be wide when it is mature.We attribute this phenomenon to the fact that silicon applications can not provide enough support to the incisions when tension is great,and the tension is an important factor of the scar formation.The effect of the surgical strip has not been proved and the tension strength of it is relatively small.In addition,the silicon applications need to be used every day and the surgical strip looks not beautiful,so the patient compliance is a problem that influence the outcomes.Plastic surgeons are always trying to find better methods to alleviate the scar formation and make the surgical incisions have better long-term outcomes.We pay our attention to the methods that could prove enough tension support to the insicions.Dermabond is a kind of skin adhesive whose component is octyl-2-cyanoacrylate.Studies showed that the tensile strength of Dermabond is comparable to 4-0 absorbablesutures and is significantly higher than that of Steri-Strips(commonly used surgical tapes).Dermabond has been widely used in Europe and America and the safety of it has been fully proved.Lots of studies have suggested that it yields similar cosmetic results to standard suture methods.In addition,the use of it could increase the satisfaction of the patients and do not increase the infection rate of the incisions.However,these studies are all about the Caucasian.There are great difference between the Asian skin and Caucasian skin.Asian skin has the characteristics of thicker dermis,more melanin and sebaceous glands.After skin injury,Asians tend to have more serious scar.Dermabond is not widely used in China and the relevant literatures are lacking and the existed literatures are only in regard to the early complications such as incision infection and split.Moreover,all these studies were conducted with the method that using Dermabond only once in the operation.None of these observed the outcomes when it was repeated used for a period of time.We speculate that if we use Dermabond repeatedly for a period of time,the scar will be alleviated and the incision will have better outcomes.The reasons are as follows.First,great local tension is considered a crucial factor of severe scar.Dermabond has good tensile strength comparable to 4-0 absorbable suture,so it could well support the incision to reduce the scar formation.Second,Dermabond is an occlusive dressing that could reduce the water evaporation to make the surrounding of incisions moist.As studies have proved,the moist surrounding contributes to alleviating the scar.Besides,Dermabond has antibacterial ability,which may also contribute to decreasing the scar formation,for studies have demonstrated that bacterial colonization is a risk factor of hypertrophic skin scarring.In addition to what is mentioned above,Dermabond also has following advantages.It is a gelatinous substance before solidification,so it can be used in all kinds of sites including where the contour is irregular.It has waterproofness so patients can bathe normally.It is colorless so has good appearance.It will fall off automatically in one or two weeks so need not to be specially treated.In conclusion,we speculate that if we use Dermabond repeatedly for a period of time,the scar will be alleviated and the incision will have better outcomes.ObjectiveTo verify whether the incisions will have lighter scar and better outcomes when we use Dermabond repeatedly for a period of time at the surgical incisions.Methods1.Patients SelectionPatients undergoing auricular reconstruction at Department of Plastic and Reconstructive Surgery,Xijing Hospital between July 2016 and March 2017 were recruited in our research.These patients all had thoracic incision to remove costal cartilage to carve cartilage framework.Specific exclusion criteria: pregnant,keloid disease or hypertrophic scar,allergic constitution,connective tissue diseases,using hormones or chemotherapy drugs,diabetes.2.Surgical ProcedureThe thoracic incision of each patient was halved into two parts and we randomized each part into treatment group or control group respectively.After costal cartilage removal,an experienced plastic surgeon sutured the incision following the standard method.The perichondrium and muscle were sutured with 3-0 Vicryl,and the superficial fascia was sutured with 4-0 Vicryl.Then,performed running subcuticular suturing using5-0 Monocryl.For the treatment hemi-side,the Dermabond was then painted over the wound edges for 2 to 3 times,and for the control hemi-side,the incision was applied with Steri-Strips.The Steri-Strips was removed at 5 days after surgery.At the postoperative 10 and 20 days,the treatment hemi-side was applied with Dermabond for the second and third time.The final follow-up time is 6 months.3.Outcome measuresThe presence of complications such as dehiscence or wound infection were evaluated when patients were in hospital.The incision gargalesthesia was scored by patients using the visual analog scale(VAS,0-10 points)when patients were in hospital.At the final follow-up visit,the scar appearance was graded by two experienced plastic surgeon(blinded to the grouping)using the Vancouver scar scale(VSS)and digital photographs of all patients were collected.After all visits are completed,another two plastic surgeons(blinded to the grouping)graded the scar appearance based on the digital photographs using VAS(0-10 points).Results16 patients were enrolled in our research,and 7 of them have completed the final follow-up.For incision gargalesthesia,the score of the treatment hemi-side was 1.00 ±0.97 and the score of the control hemi-side was 2.00 ± 0.89.The results showed statistic difference between two sides(p = 0.018).For the long-term scar appearance,the VAS showed that the score of the treatment hemi-side was 6.36 ± 1.89 and the score of the control hemi-side was 5.43 ± 1.57.The differences were of statistical significance(p =0.039).The VSS did not show the statistical differences between two sides.The score of the control hemi-side was greater than treatment hemi-side as 6.07 ± 3.13 and 5.21 ± 3.20respectively(p = 0.186).ConclusionThe incisions may have lighter scar and better outcomes when we use Dermabond repeatedly for a period of time at the surgical incisions.In addition,the using of Dermabond could alleviate the incision gargalesthesia.