Comparison of topical skin adhesive and simple interrupted nylon sutures for wound closure in forefoot surgery:a prospective randomised trial

T. Goff, R. Varrall, P. Robinson, K. Fogarty, R. Ray, A. Chang, J. Dhaliwal, P. Dearden, A. Wines

Background: There are many options for wound closure in forefoot surgery. The purpose of this study was to compare topical skin adhesive (2-Octyl-cyanoacrylate) to simple interrupted nylon sutures with attention to the quality of wound healing and acceptability to the patient.

Methdos: Patients undergoing 1st ray forefoot surgery utilising a medial incision, Hallux Valgus correction or 1st MTPJ arthrodesis, were recruited. Patients were randomised during surgery to final layer wound closure with either the intervention topical skin adhesive (TSA) or the control interrupted nylon sutures (INS). Primary outcome measured was wound care pain (VAS) at 2 weeks post operatively. Secondary outcomes assessed include time taken to perform wound closure, quality of wound healing and time taken for wound care at 2 weeks postoperatively, and patient satisfaction at 6 weeks postoperative.

Results: 70 patients (18 bilateral) were recruited, 42 feet in each study group (after 4 exclusions for incomplete data). Mean age 61 (29-83). There were no statistical differences in the demographics or surgery performed between groups. Patient reported pain was significantly less with TSA (VAS 0 vs 2, p=0.025). Time to perform wound closure was significantly slower for TSA (272secs (SD 72.2) vs 229secs (SD 58.8), p=0.0038), whilst postoperative wound care was significantly faster for TSA (71secs (SD 50.8) vs 120secs (SD 47.8), p< 0.0001). More inflammation and wound edge separation was recorded with TSA (17 vs 5 cases, p=0.006) and (12 vs 3 cases, p=0.02) respectively. A high degree of overall patient satisfaction was reported in both groups, without significant difference.

Conclusions: Topical skin adhesive and interrupted nylon sutures are both acceptable closure methods for forefoot surgery with high satisfaction rates, low pain scores and low complications. However, the observation of significantly more inflammation and areas of wound separation with topical skin adhesive is sufficient to recommend continued routine use of sutures.