Clinical Application Of Medical Tissue Adhesive For Facial Skin Lacerations In Children

BackgroundFacial skin laceration is one of the most common emergency diseases in the department of plastic surgery.Plastic surgeons constantly explore new materials and treatment in order to get better results.A large number of studies have proved that facial skin lacerations treated by plastic suture shows better treatment effect.The use of medical tissue adhesives provides a new choice for children with facial skin lacerations.Medical tissue adhesive is a material with strong histocompatibility,and its main component is N-butyl-2-cyanoacrylate.It can quickly converge into a solid film after contact with the tissue fluid,and firmly adhere to the skin,so that the wound is tightly closed.In recent years,it is gradually applied in clinical practice.With the popularization of medical tissue adhesive,a lot of studies have been conducted to compare the effect of medical tissue adhesive treatment with traditional suture treatment.However,the existing studies used different suture methods and materials,which yielded different results.And most of the studies used the traditional suture method,rather than plastic suture.Therefore,it is unclear that the clinical effect between medical tissue adhesive treatment and plastic suture,which deserves further research and analysis.In addition,when using medical tissue adhesive to treat facial skin laceration,many authors believe that the eyelid skin is thin and loose,with high mobility,and the treatment effect of medical tissue adhesive is not clear and definite,so they do not advocate adhesive treatment for eyelid laceration.At present,there is no study to compare the effect of adhesive treatment for facial skin laceration in different parts.Therefore,the effect of tissue adhesive and plastic suture for facial skin laceration in different parts,especially the eyelid,is worth studying.Purpose1.Explore and analyze the clinical application of medical tissue adhesive and plastic suture in the treatment of facial skin lacerations in children.2.Analyze and study the clinical application effect of medical tissue adhesive on eyelid skin lacerations in children.Methods(1)Children with facial skin laceration treated by the department of plastic surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to September 2021 were selected as the research subjects and divided into suture group and adhesive group according to their treatment methods.The adhesive group was then divided into eyelid group and facial adhesive group.Similarly,the suture group is divided into eyelid suture group and facial suture group.Eyelid group means skin lacerations located in the orbital area(excluding eyebrow arch),and facial group means skin lacerations excluding mouth,nasal and orbital part.After screening for the inclusion and exclusion criteria,a total of 164 cases met the study requirements and were successfully followed up until 3 to 6 months after treatment.(2)Observation index:collecting medical records of children with facial skin laceration,including age,sex,length and depth of the skin laceration;operation data include intraoperative pain degree and operation time;follow-up data include scar condition evaluation and satisfaction of the patients.① Using Face,Legs,Activity,Cry,Consolability Behavioral Tool(FLACC)scoring:immediately evaluated by a physician,Each score ranges from 0 to 2 points,The total score is 10 points,Higher scores indicate worse pain;② Operation time:recorded by the surgical assistant,Time from disinfection until laceration closed;③ Scar Assessment Using Patient And Observer Scar Assessment Scale(POSAS):Follow-up of the children and their families by doctors,All indicators were scored from 1 to 10 of these 10 grades,The higher the score is,the worse the appearance of the scar is;④Satisfaction scores of the treatment were investigated at follow-up after.(3)Treatment:All skin laceration are treated by conventional debridement strictly following the principle of sterility.The closed wound is operated in strict accordance with the operation specifications of medical tissue adhesive and plastic suture standards.After operation,a skin tensor can be used to assist the laceration to avoid postoperative wound rupture.2～3 days after wire removal or glue film shedding,the child shoul be instructed to adhere to anti-scar drugs for more than 6 months.(4)Data were analyzed statistically using SPSS 20.0 statistical software.Measurement data were tested for normality before performing the analysis.Measurement data conforming to the normal distribution are represented by mean ±standard deviation(x ± s),and non-normal distribution is represented by M(P25,P75),using two independent sample t-tests or non-parametric tests.Count data are represented as using cases(n)and percentage(%),using the chi-square test.P<0.05 was considered as a statistically significant difference.Results(1)There were 164 cases meeting the study requirements and successfully followed-up,with a follow-up rate of 92.1%,3 to 6 months after surgery,6 months,and the average follow-up time was 3.5 months.(2)General information of the children:In this study,the sex,age,wound length and wound depth of the children were not significant(P>0.05).(3)Data comparison between the adhesive and suture groups:the operation time was significantly longer in the suture group and more than the adhesive group,the pain degree was significantly greater than that of the suture group,the families of the children were less satisfied with the treatment than that of the adhesive group,and the difference between the groups was significant(P<0.001).The postoperative POSAS score in the suture group was lower than that in the adhesive group,but the difference was not significant(P>0.05).And the cost of the adhesive group is only about 20%of the suture group.(4)All the children in each group successfully completed the operation,no conversion to suture in the adhesive group,no intraoperative allergy in the suture group,and the wounds in all groups were primary healing.Among them,there were 5 children(2 in eyelid adhesion group,1 in eyelid suture group,1 in facial adhesion group and 1 in facial suture group)with mild red and swollen in the surgical area,which subsided spontaneously after several days of observation without special treatment.(5)Data comparison between the eyelid adhesion group and the eyelid suture group:the operation time was significantly longer than the eyelid suture group,the pain degree of the eyelid suture group was greater than the eyelid adhesion group,the family members had higher satisfaction with treatment than the eyelid suture group,and the difference between the two groups was statistically significant(P<0.05).The postoperative POSAS score in the eyelid suture group was lower than that in the eyelid adhesion group,but the difference was not significant(P>0.05).(6)Data comparison between the facial adhesion group and the facial suture groups:the operation time of the facial suture group was significantly longer than the eyelid adhesion group,the pain degree of the facial suture group was greater than the eyelid adhesion group,the families of the facial adhesion group were more satisfied with the treatment than the eyelid suture group,and the difference between the two groups was statistically significant(P<0.05).The postoperative POSAS score in the facial suture group was lower than that in the adhesive group,but it was not significant(P>0.05).(7)Data comparison between the eyelid and maxillofacial adhesion groups:the operation time of the eyelid adhesive group was significantly longer than the maxillofacial adhesion group,the pain degree of the eyelid adhesive group was significantly greater than the maxillofacial adhesion group,the eyelid adhesive group was less satisfied than the maxillofacial adhesion group,and the difference between the two groups was statistically significant(P<0.05).The postoperative POSAS score of the maxillofacial adhesion group was lower than that of the eyelid adhesion group,but the difference was not significant(P>0.05).Conclusion1.Compared with plastic suture,treating facial skin laceration with tissue adhesive glue is less costly,easy manipulation,less pain and less scar.At the same time,the parents are generally more satisfied.So that treating facial skin laceration with tissue adhesive glue has obvious advantages,so it is worth promoting and use in clinical practice.2.For superficial eyelid skin laceration,the treatment of using medical tissue adhesive is more recommended.