Systematic Review and Meta-Analysis of Surgical Zipper Technique versus Intracutaneous Sutures for the Closing of Surgical Incision

Abstract

BackgroundIt is controversial whether surgical zipper technique (SZT), a non-invasive method of surgical wound closure, achieves a better outcome of incision healing than intracutaneous sutures (IS) in the surgery. This meta-analysis was performed to systematically analyze whether surgical zipper is superior to suture material for the incision closure.MethodsDatabases and reference lists were searched for randomized controlled trials (RCTs) comparing SZT with IS for the incision closure.ResultsFour RCTs with 678 patients were identified and analyzed. Compared with IS, SZT achieved similar incidence of postoperative complications, less time for incision closure, less cost of both surgeons’ time and operating room time, no need for removing sutures and more comfort for the patients. Besides, SZT achieved perfect aesthetic results in various types of incisions with the exception of those with substantial curvatures, those with secretions, in obese patients or those under high tension.ConclusionThe non-invasive zipper technique may be a more attractive option of incision closure in a wide spectrum of surgical areas.

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta‐analysis

“…23 Although several metaanalyses had attempted to clarify the differential SSI risk between skin closure modalities, an ideal modality with both anti-infection and cosmesis effects remains uncertainly as wound cosmesis is currently considered more important than it was previously. 5,7,11,24 Tissue adhesives may provide a better cosmetic result but they are used less widespread due to the problems with wound dehiscence. A novel zipper skin closure device has been developed to overcome these problems, but no significantly difference of SSI between the zipper and subcuticular sutures was found in the previous meta-analyses.…”

“…A novel zipper skin closure device has been developed to overcome these problems, but no significantly difference of SSI between the zipper and subcuticular sutures was found in the previous meta-analyses. 5,11 In order to expand sample size, a related study published in 2019 17 was added, and two additional studies (one adopted conventional nylon suture, 19 one not mentioned subcuticular 18 ) were also included in view of…”

“…8 The similar incidence of SSI between the zipper and sutures was reported. 5,11 Two previous meta-analyses of randomised controlled trials (RCTs) on this topic have been published in 2016 and 2020, respectively. 5,11 However, both were limited by small sample sizes with very low-certainty evidence.…”

“…5,11 Two previous meta-analyses of randomised controlled trials (RCTs) on this topic have been published in 2016 and 2020, respectively. 5,11 However, both were limited by small sample sizes with very low-certainty evidence. Consequently, we perform an updated metaanalysis by combining five RCTs [12][13][14][15][16] from prior metaanalyses and three additional studies [17][18][19] (two RCTs) in order to clarify the state of the evidence.…”

“…It is sterile, adjustable, hydrocolloid adhesive‐based, and designed to replace staples and sutures for closure of the superficial skin layer, which can be applied directly to intact skin on either side of the incision and provides uniform force along the wound edge 8 . The similar incidence of SSI between the zipper and sutures was reported 5,11 . Two previous meta‐analyses of randomised controlled trials (RCTs) on this topic have been published in 2016 and 2020, respectively 5,11 .…”