Document Detail

Lacerations against Langer's lines: to glue or suture?
MedLine Citation:
PMID:  9543399     Owner:  NLM     Status:  MEDLINE    
This study evaluated the effects of initial wound orientation on the cosmetic outcome of facial lacerations repaired with histoacryl blue (HAB), a tissue adhesive, vs. conventional suturing. This was a retrospective analysis of patients from a prospective randomized clinical trial on the use of HAB. Children in the initial cohort who had facial lacerations and were also evaluated for cosmetic appearance at a 2-month follow-up appointment were eligible. Orientation along Langer's Lines, which define the functional anatomy of the underlying structures to the skin, was determined by two investigators blinded to the initial method of repair. Photographs of the wounds were reviewed and the wounds were categorized as being: Langer (+) (<20 degrees deviated from Langer's Lines) or Langer (-) (> or =20 degrees deviated from Langer's Lines). Photographic appearance at follow-up was evaluated using a 100-mm visual analog scale (0=best, 100=worst) by two plastic surgeons blinded to the method of repair. Sixty-one patients were enrolled in the initial cohort, with 55 (90%) evaluated at the 2-month follow-up. Forty-eight of the 55 (87%) had facial lacerations, therefore meeting present study criteria: [HAB (n=26), Suturing (n=22), Langer (+) (n=27), Langer (-) (n=21)]. Langer (+) patients were comparable to Langer (-) for demographics, wound characteristics, and method of repair. There was no difference in overall cosmetic appearance of facial wounds closed with HAB vs. conventional suturing. Follow-up appearance was significantly worse for sutured Langer (-) vs. Langer (+) wounds. In contrast, cosmetic appearance of lacerations closed by HAB were comparable between Langer (-) and Langer (+) wounds. In conclusion, initial wound orientation had a greater impact on the cosmetic appearance for lacerations closed by suturing compared to HAB. HAB may be the preferred method of cutaneous closure for facial lacerations oriented against Langer's Lines.
H K Simon; W T Zempsky; T B Bruns; K M Sullivan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  16     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:    1998 Mar-Apr
Date Detail:
Created Date:  1998-05-22     Completed Date:  1998-05-22     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  185-9     Citation Subset:  IM    
Department of Pediatrics, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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MeSH Terms
Child, Preschool
Enbucrilate / analogs & derivatives*,  therapeutic use
Facial Injuries / surgery,  therapy*
Retrospective Studies
Scalp / injuries
Suture Techniques*
Tissue Adhesives / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Tissue Adhesives; 6606-65-1/Enbucrilate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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