Difference In Cosmesis Research Articles

Abstract PO5-18-03: A Randomized Controlled Trial to Evaluate the Safety and Efficacy of 1 cm versus 2 cm resection margins in Phyllodes Tumours of the Breast - An Exploratory Study

Abstract Introduction Phyllodes tumors are rare fibroepithelial tumors constituting 0.3-1% of breast tumors. It presents as a rapidly growing breast lump, with a bosselated surface and overlying shiny stretched skin with dilated prominent veins. Diagnosis is made by mammography and ultrasonography and tissue diagnosis is made by core needle biopsy. The tumor is known for its propensity to grow rapidly within the mesenchymal elements of breast tissue, and to locally recur. Surgery with adequate margins of excision has been known to prevent local recurrence. Phyllodes tumors have inspired much debate among surgeons, regarding the extent of margins during resection. These margins have been defined clearly for carcinoma of the breast (no ink on tumor) but the same consensus has not been reached for Phyllodes tumor. We carried out the world’s first randomized trial to settle the debate to compare the effects of a 1cm margin with that of a 2 cm margin, aiming to arrive at a consensus on the appropriate surgical margin to prevent re-excision and recurrences. We also aimed to compare cosmetic outcomes both subjectively and objectively between the 2 arms. Materials and Methods We carried out a prospective exploratory randomized control trial on patients with suspected phyllodes tumors of the breast from July 2020 to January 2022. After establishing diagnosis, and obtaining informed consent, patients were randomized to either of the 2 arms, to undergo resection with a lcm vs a 2 cm margin. Intraoperatively, the margin of the tumor was delineated by ultrasound for maximum accuracy. The incision made was deepened through the breast and pectoralis major muscle at a distance of exactly 1 cm or 2 cm from the tumor edge. The entire mass was excised en bloc with a 3 dimensional clearance from all sides. If the tumor was found infiltrating the underlying muscle (e.g Pectoralis major muscle, Serratus anterior), a full thickness section of the muscle was also excised with the specimen. The patients were followed up every 3 months with clinical examination and ultrasonography (followed by core needle biopsy for any suspicious mass), for a period of 12-18 months, to evaluate for recurrence.Cosmesis was evaluated by a 5-point Likert scale evaluated by the patient and the surgeon, and objectively using Breast Retraction Assessment and Nipple Deviation. Results We analysed the results of 41 patients who underwent surgery for Phyllodes tumor of the breast. All patients had negative margins after surgery. The mean margin distance (SD) in the 1 cm arm was 0.69 (0.20) cm and 1.83 (0.67) cm in the 2 cm arm. which was statistically significant between the groups. On the follow up ultrasound examination at 12 months, 1 patient (5.3%) was found to have a locoregional recurrence, but this was not statistically significant. There was no statistically significant difference in cosmesis between the arms. Conclusions We achieved our primary objective of histologically negative margins in all patients within both the groups. However, due to the limited number of patients recruited in the study, and due to the short duration of follow-up, we are not able to report significance in terms of recurrences between the 2 groups, to advocate for one over the other. The practice in our unit has been the 2 cm margin, as it offers good oncological outcomes and is definitely safe. Given that cosmetic outcomes were comparable in both arms, one can be assured that a 2 cm margin does not offer worse cosmesis compared to a 1 cm margin. However, our study at this point in time, establishes non inferiority of a 1 cm margin. There have been no randomized control trials conducted in world literature to influence guidelines and clinical practice regarding the ideal margin resection for phyllodes tumor. Our study would be the first of its kind, and is a novel concept not yet conducted for phyllodes tumor. We will continue this trial for years to come, and hope to generate level I data, with increased patient enrolment and a longer duration of follow up. Citation Format: Vandhana Rajgopal, Anita Dhar, Kamal Kataria, Piyush Ranjan, Anurag Srivastava. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of 1 cm versus 2 cm resection margins in Phyllodes Tumours of the Breast - An Exploratory Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-18-03.

Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes

Objective Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. Methods REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. Results At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001). Conclusions Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.

Detailed Sub-study Analysis of the SECRAB Trial: Quality of Life, Cosmesis and Chemotherapy Dose Intensity

AimsSECRAB was a prospective, open-label, multicentre, randomised phase III trial comparing synchronous to sequential chemoradiotherapy (CRT). Conducted in 48 UK centres, it recruited 2297 patients (1150 synchronous and 1146 sequential) between 2 July 1998 and 25 March 2004. SECRAB reported a positive therapeutic benefit of using adjuvant synchronous CRT in the management of breast cancer; 10-year local recurrence rates reduced from 7.1% to 4.6% (P = 0.012). The greatest benefit was seen in patients treated with anthracycline–cyclophosphamide, methotrexate, 5-fluorouracil (CMF) rather than CMF. The aim of its sub-studies reported here was to assess whether quality of life (QoL), cosmesis or chemotherapy dose intensity differed between the two CRT regimens. Materials and methodsThe QoL sub-study used EORTC QLQ-C30, EORTC QLQ-BR23 and the Women's Health Questionnaire. Cosmesis was assessed: (i) by the treating clinician, (ii) by a validated independent consensus scoring method and (iii) from the patients' perspective by analysing four cosmesis-related QoL questions within the QLQ-BR23. Chemotherapy doses were captured from pharmacy records. The sub-studies were not formally powered; rather, the aim was that at least 300 patients (150 in each arm) were recruited and differences in QoL, cosmesis and dose intensity of chemotherapy assessed. The analysis, therefore, is exploratory in nature. ResultsNo differences were observed in the change from baseline in QoL between the two arms assessed up to 2 years post-surgery (Global Health Status: –0.05; 95% confidence interval –2.16, 2.06; P = 0.963). No differences in cosmesis were observed (via independent and patient assessment) up to 5 years post-surgery. The percentage of patients receiving the optimal course-delivered dose intensity (≥85%) was not significantly different between the arms (synchronous 88% versus sequential 90%; P = 0.503). ConclusionsSynchronous CRT is tolerable, deliverable and significantly more effective than sequential, with no serious disadvantages identified when assessing 2-year QoL or 5-year cosmetic differences.

Hypofractionated Radiation Therapy in Keratinocyte Carcinoma

Hypofractionated radiation therapy regimens are well suited to the management of keratinocyte carcinomas. Most lesions are small, superficial and not close to critical organs at risk. Fewer visits to the cancer centre are advantageous for the frail and elderly patient population. No difference in cosmesis or local control has been found when comparing hypofractionated with conventionally fractionated radiation therapy schedules, although most of the data in the literature are retrospective, highlighting the need for prospective trials. As keratinocyte carcinomas can present anywhere on the skin surface, a wide variety of techniques may be used to optimise treatment delivery, including external beam radiation with kilovoltage, electron beams and megavoltage photons. Brachytherapy can also be used with radionuclide and electronic-based applicators, surface applicators and interstitial techniques for lesions >5 mm deep. Stereotactic body radiotherapy, or extreme hypofractionation, is an emerging treatment option that delivers an ablative dose to the tumour while minimising dose to organs at risk through precision planning and delivery techniques. Frail elderly patients with medically inoperable disease not suitable for conventionally fractionated radiation therapy may achieve durable locoregional control with dose escalation. Ongoing studies following local control and toxicity are warranted. The aim of this article is to provide clinical oncologists with an overview of hypofractionation for keratinocyte carcinomas.

​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite.

Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review. To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds. In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite. Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated. All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.

Comparison of wound strength, histologic, and aesthetic outcomes after microsurgical versus conventional skin closure in a rat model

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague–Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5–10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p < 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden.

Comparison of Cosmesis and Body Image After Laparoendoscopic Single-Site Versus Conventional Laparoscopic Donor Nephrectomy

BackgroundThis study used a questionnaire to objectively assess the body image of donors who underwent conventional laparoscopic donor nephrectomy (L-DN) or laparoscopic single-site donor nephrectomy (LESS-DN). Surgical outcomes were compared between the two groups. MethodsTwenty patients underwent L-DN and 20 underwent LESS-DN. The postoperative outcomes of the two approaches were retrospectively compared and evaluated for differences in cosmesis and body image. The questionnaire comprised a body image questionnaire, including a body image scale (BIS) and cosmetic scale (CS), and a photo-series questionnaire (PSQ). A higher score indicated a more favorable assessment. Pain was assessed by comparing the number of times an analgesic was administered during hospitalization. ResultsThere were no significant differences in operative outcomes between L-DN and LESS-DN. The average BIS score (maximum possible, 20 points) was 18.5 points for patients who underwent L-DN and 19.5 points for patients who underwent LESS-DN (P = .025). Patients who underwent L-DN had a median CS score (maximum possible, 24 points) of 17.5 points, whereas patients who underwent LESS-DN had a median CS score of 19.0 points (P = .113). The average PSQ score was 7.1 points for patients who underwent L-DN and 8.8 points for patients who underwent LESS-DN (P = .01). Patients who underwent LESS-DN were administered an analgesic was significantly number of times less than patients who underwent DN (P = .01). ConclusionsLESS-DN results in a better body image and better cosmetic appearance than does L-DN, indicating the clinical usefulness of LESS-DN.

A Unique Case of Bilateral High Ulnar Nerve Laceration

High ulnar nerve injuries are now commonly treated with a distal nerve transfer, in which the anterior interosseuos nerve to pronator quadratus is coapted to the deep ulnar nerve motor branch. Herein, the authors describe a case of bilateral ulnar nerve laceration that provides an opportunity to directly compare two operative techniques on different extremities of the same patient. The patient sustained bilateral ulnar nerve injuries 6 cm superior to the medial epicondyle. The right ulnar nerve was proximally repaired with primary neurorraphy and a distal motor nerve transfer. The left ulnar nerve underwent primary nuerorraphy without a nerve transfer because the median nerve was mistakenly tied off to control bleeding. Physical examination and nerve conduction studies two years postsurgical intervention demonstrated an undeniable difference in cosmesis and function. The clinical findings suggest a superior result with a combined primary neurorraphy and a distal nerve transfer compared with a primary neurorraphy alone.

Abstract P2-14-09: Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy

Abstract Approximately 30-40% of women are not offered immediate breast reconstruction because the possibility of post-mastectomy radiotherapy (PMRT) is unknown at the time of mastectomy. Breast reconstruction may be delayed until final pathology is available and need for radiotherapy established. Surgical literature is replete with studies of varying quality, reporting complication rates for a range of reconstructive procedures, highlighting the need for surgical trials of reconstructive techniques in women at risk of PMRT. Decisions for these patients are complex, involving multiple clinicians including surgeons and oncologists. To inform a surgical trial design, we aimed to determine current UK surgical practice and gain an understanding of the drivers behind decision-making. Methods: A questionnaire, validated in a pilot population, was posted to Consultant members of the Association of Breast Surgery (UK). We collected data on current practice in conducting Delayed, Immediate and Delayed-immediate reconstructive surgery. We collated data on type and volume of procedure performed and factors affecting decision-making including delay to adjuvant treatment, risk of complications, perception of patients’ quality of life (QoL) and aesthetic satisfaction. Results: Of 355 surgeons, 130(37%) responded. Of these, 77% felt the current evidence base was not adequate to guide surgical decisions and 80% felt a need for further trials to guide best treatment. Despite a lack of scientific evidence demonstrating a difference in cosmesis or QoL between Immediate and Delayed reconstruction, 85% felt there is not equivalent cosmesis and 71% felt there is not equivalent QoL between the two groups. There is considerable heterogeneity in reconstructive approach to patients at risk of PMRT (Table 1). Delayed reconstruction remains the most popular option, being regularly used by 94% of surgeons despite only 34% of surgeons believing the majority of patients are satisfied with the approach. Significantly fewer surgeons perform Immediate implant based reconstruction (with or without ADM) than Delayed (p&amp;lt;0.01). Implant reconstruction is performed by 71% of surgeons in patients at risk of PMRT, but only 44% of surgeons felt patients were happy with the final results. Table 1 No. of responses NeverSometimesOftenAlwaysDelayed5505119Immediate implant584181Immediate ADM+Implant45491452-stage (delayed-immediate) Expander to permanent reconstruction2855335Immediate Autologous2959227 The three most important drivers in making a reconstructive choice were 1. Effect of PMRT on the cosmetic result 2. Minimising risk of complications and avoiding delay to adjuvant treatment 3. Pre-operative uncertainty over the need for PMRT. Conclusions: Surgeons employ a variety of approaches to reconstruction in the face of PMRT, the most common approach being delayed reconstruction. Decision-making is based upon individual surgeon’s perception of risks including likely delay to adjuvant therapy and effect of PMRT on the reconstruction. Drivers appeared to be more surgeon-centred rather than patient-based. There is awareness of a lack of evidence to support decision-making and the need for high quality studies. Randomised clinical trials are needed to provide an evidence base for outcomes. Citation Format: James R Harvey, Nigel J Bundred, Cliona C Kirwan, Ashu Gandhi, Paula J Duxbury. Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-09.

LiquiBand® Surgical S topical adhesive versus sutures for the closure of laparoscopic wounds. A randomized controlled trial

Cyanoacrylate adhesives offer the surgeon and patient an alternative to subcuticular suturing. LiquiBand® Surgical S (LBSS) is a new formulation with a blend of monomeric n-butyl and 2-octyl cyanoacrylates. In this study, the effectiveness, safety, and clinical utility of LBSS was compared to Vicryl™ sutures for the closure of laparoscopic incisions. This was a prospective randomized study of LBSS skin adhesive versus Vicryl™ sutures for the topical closure of laparoscopic surgical incisions. Subjects were asked to return at 2 weeks postsurgery to report complications and adverse events. Wounds were evaluated for apposition and cosmesis using a modified Hollander Wound Evaluation Scale (HWES). The Shapiro–Wilk test of normality was done. Independent-samples T test, Mann Whitney U test, and chi-square test were used to compare variables between the two wound closure methods. A total of 114 subjects participated in this trial completing all aspects of the study. Fifty-five subjects received sutures for topical wound closure, with 59 subjects receiving LBSS. Surgeons were found to be satisfied with 100 % of all applications using the LBSS device. One hundred percent of wounds closed with sutures and 98.9 % wounds closed with LBSS achieving an optimal HWES of 0. There was no statistical difference in cosmesis or complications for either method. Closure with LBSS was significantly faster by a mean of 2 min. LiquiBand® Surgical S is as good as sutures for the closure of laparoscopic wounds in terms of cosmesis and complications with the added benefit of being significantly faster.

253PD - SECRAB (Sequencing of Chemotherapy and Radiotherapy in Adjuvant Breast Cancer) Cosmesis Results

ABSTRACT Background SECRAB, a randomised trial comparing sequential (Seq) to synchronous (Syn) chemo-radiation using a CMF or Anthracycline-CMF regimen, demonstrates reduces local recurrence rates after Syn treatment for early breast cancer (EBC) (Fernando 2011 EJC:47 S2). Cosmesis study results are presented. Methods 2296 women were randomised and cosmesis was assessed in 382. Cosmesis and telangiectasia were assessed as excellent, good, moderate and poor for patients having wide local excision (WLE) while telangiectasia alone was assessed for those having mastectomy. Photographs were taken for 301 patients for blinded independent review using a consensus method (Haviland 2008 Clin Oncol 20:497). Patient perception was assessed using EORTC BR23 quality of life questionnaire (Q 39-42). Assessments were made at baseline, 1, 2 and 5 years post surgery. Results The results of clinician assessed cosmesis and telangiectasia are shown below. There was no statistically significant difference between the arms Table: 253PD Category Odds Ratio (OR) Excellent Good Moderate/Poor (95% CI) Seq Syn Seq Syn Seq Syn Excellent/good vs moderate/poor Cosmesis, n (%) 14 (23) 15 (21) 37 (60) 37 (51) 11 (18) 21 (29) 1.87, (0.82,4.27) p = 0.1 Telangiectasia, n (%) 79 (68) 99 (62) 33 (28) 54 (34) 4 (4) 7 (4) 1.28, (0.37,4.48) p = 0.7 Data on independent assessment of change in breast appearance after WLE was available for 145 (98%) patients. Minimal, mild and marked changes were observed in 70, 29 and 1% of patients respectively for the Syn arm and 72, 28 and 0% for the Seq arm. There was no difference between treatment arms (OR, mild/marked vs minimal, 1.10, 95% CI 0.54-2.26, p = 0.8). There was no change in patient's perception of their breast appearance (baseline vs. final assessment questionnaire). Conclusions There was no significant difference in cosmesis or telangiectasia between the two arms as assessed by the clinician or by independent photographic review. There was no difference in patient perception of breast appearance. Contrary to the result of the main study, which showed a borderline significant worsening of telangiectasia in the Syn arm, no such difference was seen in the cosmesis study. Syn chemo-radiation reduces local recurrence in EBC without affecting cosmesis. Disclosure All authors have declared no conflicts of interest.

Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials.

To summarize the best available evidence for the effect of tissue adhesives (TAs) in managing traumatic lacerations in children and adults. A search was conducted using the Cochrane Controlled Trials Register, Medline, and EMBase for relevant studies. The authors also searched the citations of selected studies and contacted relevant authors and manufacturers. The search included randomized controlled trials (RCTs) comparing a TA versus standard wound closure (sutures, staples, adhesive strips) (SWC) or two TAs for acute, linear, low-tension, traumatic lacerations in an emergency or primary care setting. Data were extracted by one reviewer and checked for accuracy by a second reviewer. Two reviewers independently assessed masked copies for quality. Outcomes of cosmesis (subgroups of age, wound location, and need for deep sutures), pain, procedure time, ease of use, and complications were analyzed separately for two comparisons: 1). TA versus SWC; and 2). TA versus TA. Eight studies compared a TA with SWC. No significant difference was found for cosmesis at any time point examined. Subgroup analysis was possible only for age; no significant difference was found. Pain scores [Parent Visual Analogue Scale weighted mean difference (VAS WMD) = -15.7 mm; 95% CI = -21.9 to -9.5] and procedure time (WMD = -5.7 minutes; 95% CI = -8.2 to -3.1) significantly favored TAs. Small, statistically significant risk differences were found for dehiscence [favoring SWC; number needed to harm (NNH) = 25; 95% CI = 14 to 100] and erythema (favoring TAs; NNH = 8; 95% CI = 4 to 100). Only one study compared two TAs (butylcyanoacrylate versus octylcyanoacrylate) for pediatric facial lacerations. No significant difference was found for cosmesis, pain, procedure time, or complications. TAs are an acceptable alternative to SWC for simple traumatic lacerations. No difference in cosmesis was found between TAs and SWC, or between different TAs. Tissue adhesives offer the benefits of decreased procedure time and less pain, compared with SWC. A small increased rate of dehiscence with TAs must be considered when choosing the closure method (NNH = 25).