Comparing the Treatment Outcomes of Absorbable Sutures, Nonabsorbable Sutures, and Tissue Adhesives in Cleft Lip Repair: A Systematic Review

Abstract

Objectives: To examine the literature and synthesize the available reports for the best possible option between absorbable, nonabsorbable, and tissue adhesives in cleft lip skin closure. Design: We conducted systematic searches for randomized controlled trials and controlled clinical trials in PubMed, Cochrane, Ovid Medline, and OpenGrey databases. Identified studies were retrieved and assessed for eligibility. All statistical analyses were done with Revman, version 5.4. Interventions: The intervention considered in this systematic review were techniques of cleft lip repair using resorbable sutures, nonabsorbable sutures, medical adhesives, or any combination of these. Outcome Measures: The primary outcomes assessed in the trials had to include any combination of the following: wound healing cosmesis and wound healing complications. While secondary outcomes considered were quality of life, direct and indirect costs to patients and health services, and participant satisfaction. Results: Only 6 studies met all inclusion criteria and were selected for qualitative analysis. A more favorable wound healing cosmesis was seen when nonabsorbable suture was used in cleft lip repair compared to absorbable sutures and tissue adhesives (CI, 0.65-4.35). This advantage was overshadowed by the significantly higher prevalence of postoperative complications when nonabsorbable sutures are used. Conclusion: Although the results point to more favorable cosmesis with nonabsorbable sutures and an overall more favorable outcome with either absorbable sutures or tissue adhesives, the 6 selected studies were assessed at an unclear risk of bias; therefore, the results of this study should be interpreted with caution and regarded as low-certainty evidence.

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

“…73 Nonabsorbable sutures have been described as outperforming absorbable sutures in tensile strength, resulting in better tissue approximation, and thus improved would healing. 74 Regarding cleft lip repair, Egbunah et al 6 found nonabsorbable sutures to provide better wound healing cosmesis conditions, with, however, more postoperative complications when compared with absorbable sutures. Others found a tissue glue (Dermabond) to perform similarly to 6-0 Monocryl suture in terms of parentreported and surgeon-reported cosmetic satisfaction and overall rate of complications.…”

“…Although roughly half of all included studies related to patient pain and analgesia, others focused on topics ranging from the utility of perioperative antibiotics, risk factor analysis, suture materials, inpatient versus outpatient surgical outcomes, and timing of the surgical procedure on complication rates. 6,41,50,56,63,64 Such a comprehensive approach to identifying PS and QI strategies allows for more impactful and contextual practice recommendations.…”

“…6,[52][53][54] Two of the studies focused mainly on wound closure. 6,53 Of these studies, 1 compared the use of absorbable sutures to nonabsorbable sutures and tissue adhesive in cleft lip repair. 6 The authors of this study found that although nonabsorbable sutures led to more favorable wound healing cosmesis conditions, they resulted in more postoperative complications.…”

“…6,53 Of these studies, 1 compared the use of absorbable sutures to nonabsorbable sutures and tissue adhesive in cleft lip repair. 6 The authors of this study found that although nonabsorbable sutures led to more favorable wound healing cosmesis conditions, they resulted in more postoperative complications. The other article compared tissue glue (Dermabond) to Monocryl suture for lip closure in cleft lip surgery.…”

“…Optimizing PS can range from reducing postoperative opioid intake2 to minimizing intraoperative bleeding and postoperative fistula formation 3. Improving the safety and quality of cleft surgery involves a close examination of surgical outcomes with a focus on modifiable patient, surgeon, and system parameters, such as optimal analgesia practices, surgical timing, and postoperative wound management 4–6…”