A review of epidermal closure materials in dermatologic surgery: Impact on cosmetic outcome, infection and cost.
Main Article Content
Abstract
The selection of epidermal closure material in dermatologic surgery is influenced by multiple factors, including the type of material (absorbable vs. non-absorbable, and tissue adhesive), tension, postoperative bleeding/infection risk, cosmetic outcome and cost. This review article focuses on the different epidermal closure materials commonly utilized in dermatologic surgery and examines their impact on cosmetic outcome, infection rate and cost. Tissue adhesives provide comparable cosmetic outcomes to sutures and may offer a slight advantage in certain cases. Infection rates are lower with tissue adhesives due to their bactericidal properties, while absorbable and non-absorbable sutures show similar infection risks. Cost analysis reveals minor differences, with tissue adhesives and sutures having comparable overall expenses when factoring in material costs and follow-up care. The choice of closure material should be guided by wound characteristics, patient preference, and clinical context.
Keywords:
Epidermal closure, Dermatologic surgery, Tissue adhesive, Cosmetic outcome, Infection rate, Surgical wound closure
Article Details
How to Cite
KAYE, Hannah; DECKER, Ashley.
A review of epidermal closure materials in dermatologic surgery: Impact on cosmetic outcome, infection and cost..
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6570>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6570.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. A review of sutures and other skin closure materials. J Am Acad Dermatol. 2011;64(2):AB169. doi:10.1016/j.jaad.2010.09.692
2. Regula CG, Yag-Howard C. Suture Products and Techniques: What to Use, Where, and Why. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2015;41 Suppl 10:S187-200. doi:10.1097/DSS.0000000000000492
3. Azmat CE, Council M. Wound Closure Techniques. In: StatPearls. StatPearls Publishing; 2025. Accessed March 17, 2025. http://www.ncbi.nlm.nih.gov/books/NBK470598/
4. Yag-Howard C. Sutures, needles, and tissue adhesives: a review for dermatologic surgery. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2014;40 Suppl 9:S3-S15. doi:10.1097/01.DSS.0000452738.23278.2d
5. Byrne M, Aly A. The Surgical Suture. Aesthet Surg J. 2019;39(Supplement_2):S67-S72. doi:10.1093/asj/sjz036
6. Suture and Needle Characteristics in Orthopaedic Surgery. Accessed March 26, 2025. https://oce-ovid-com.ezproxy.rowan.edu/article/01874474-202007000-00005/HTML#context-tbl3
7. Zhou P, Tian J, Li C, Tang Z. Comparative Study of Durability Behaviors of Thermoplastic Polypropylene and Thermosetting Epoxy Exposed to Elevated Temperature, Water Immersion and Sustained Bending Loading. Polymers. 2022;14(14):2953. doi:10.3390/polym14142953
8. Seger EW, McClure SP, Neill BC, Jibbe A. Fast absorbing gut sutures in dermatologic surgery: a systematic review and meta-analysis. Arch Dermatol Res. 2024;316(7):1-7. doi:10.1007/s00403-024-02973-7
9. Jenkins LE, Davis LS. Comprehensive Review of Tissue Adhesives. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2018;44(11):1367-1372. doi:10.1097/DSS.0000000000001576
11. Aboul-Fettouh N, Marzolf S, Smith JM, Srivastava D, Nijhawan RI. Patient satisfaction and preference for absorbable versus nonabsorbable sutures for linear repairs. J Am Acad Dermatol. 2018;79(3):561-562. doi:10.1016/j.jaad.2018.02.020
12. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds - PubMed. Accessed March 17, 2025. https://pubmed.ncbi.nlm.nih.gov/14623686/
13. Moran B, Humphrey S, Seal A, Berkowitz J, Zloty D. Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: A randomized clinical trial. J Am Acad Dermatol. 2020;83(5):1395-1399. doi:10.1016/j.jaad.2020.06.016
14. Rosenzweig LB, Abdelmalek M, Ho J, Hruza GJ. Equal cosmetic outcomes with 5-0 poliglecaprone-25 versus 6-0 polypropylene for superficial closures. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2010;36(7):1126-1129. doi:10.1111/j.1524-4725.2010.01594.x
15. Eisen DB, Zhuang AR, Hasan A, Sharon VR, Bang H, Crispin MK. 5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial. Arch Dermatol Res. 2020;312(3):179-185. doi:10.1007/s00403-019-02009-5
16. Majd A, Lim C, Zloty D. Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2022;48(12):1289-1293. doi:10.1097/DSS.0000000000003625
17. Kim J, Singh Maan H, Cool AJ, Hanlon AM, Leffell DJ. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery. J Clin Aesthetic Dermatol. 2015;8(2):24-29.
18. Sniezek PJ, Walling HW, DeBloom JR, et al. A randomized controlled trial of high-viscosity 2-octyl cyanoacrylate tissue adhesive versus sutures in repairing facial wounds following Mohs micrographic surgery. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2007;33(8):966-971. doi:10.1111/j.1524-4725.2007.33199.x
19. Kwapnoski Z, Doost MS, Vy M, Eisen DB. Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol. 2024;90(3):577-584. doi:10.1016/j.jaad.2023.10.028
20. Handschel JGK, Depprich RA, Dirksen D, Runte C, Zimmermann A, Kübler NR. A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds. Int J Oral Maxillofac Surg. 2006;35(4):318-323. doi:10.1016/j.ijom.2005.10.003
21. Zhuang AR, Beroukhim K, Armstrong AW, Sivamani RK, Eisen DB. Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2020;46(5):628-634. doi:10.1097/DSS.0000000000002076
22. Bartenstein DW, Cummins DL, Rogers GS. A Prospective, Randomized, Single-Blind Study Comparing Cyanoacrylate Adhesives to Sutures for Wound Closure in Skin Cancer Patients. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2017;43(11):1371-1378. doi:10.1097/DSS.0000000000001200
23. Toriumi DM, O’Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg. 1998;102(6):2209-2219. doi:10.1097/00006534-199811000-00062
24. Saxena A, Dubey M, Saha GK, Tiwari D, Tyagi S, Singh RA. A Prospective Comparison of Octyl-2-Cyanoacrylate and Suture in Facial Wounds. J Pharm Bioallied Sci. 2023;15(Suppl 2):S1145-S1148. doi:10.4103/jpbs.jpbs_187_23
25. Balkawade R, Asnani U, Natarajan S, Baviskar P, Ahuja S, Patkar N. Comparative Evaluation of the Aesthetic Outcomes of Octyl-2-Cyanoacrylate Skin Adhesive and Ethilon Suture in Maxillofacial Surgery - A Randomised Clinical Study. Ann Maxillofac Surg. 2024;14(1):10-14. doi:10.4103/ams.ams_182_23
26. Tierney EP, Moy RL, Kouba DJ. Rapid absorbing gut suture versus 2-octylethylcyanoacrylate tissue adhesive in the epidermal closure of linear repairs. J Drugs Dermatol JDD. 2009;8(2):115-119.
27. Bernard L, Doyle J, Friedlander SF, Eichenfield LF, Gibbs NF, Cunningham BB. A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents. Arch Dermatol. 2001;137(9):1177-1180. doi:10.1001/archderm.137.9.1177
28. Fosko SW, Heap D. Surgical pearl: an economical means of skin closure with absorbable suture. J Am Acad Dermatol. 1998;39(2 Pt 1):248-250. doi:10.1016/s0190-9622(98)70084-2
29. Walkosak CC, Jennings T, Coriell P, et al. Infection rate using tissue adhesive versus suture for epidermal closure in dermatologic surgery: A retrospective cohort study. J Am Acad Dermatol. 2025;92(3):579-582. doi:10.1016/j.jaad.2024.10.039
30. Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives. Accessed March 17, 2025. https://onlinelibrary.wiley.com/doi/10.1111/j.1742-4801.2005.00130.x
2. Regula CG, Yag-Howard C. Suture Products and Techniques: What to Use, Where, and Why. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2015;41 Suppl 10:S187-200. doi:10.1097/DSS.0000000000000492
3. Azmat CE, Council M. Wound Closure Techniques. In: StatPearls. StatPearls Publishing; 2025. Accessed March 17, 2025. http://www.ncbi.nlm.nih.gov/books/NBK470598/
4. Yag-Howard C. Sutures, needles, and tissue adhesives: a review for dermatologic surgery. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2014;40 Suppl 9:S3-S15. doi:10.1097/01.DSS.0000452738.23278.2d
5. Byrne M, Aly A. The Surgical Suture. Aesthet Surg J. 2019;39(Supplement_2):S67-S72. doi:10.1093/asj/sjz036
6. Suture and Needle Characteristics in Orthopaedic Surgery. Accessed March 26, 2025. https://oce-ovid-com.ezproxy.rowan.edu/article/01874474-202007000-00005/HTML#context-tbl3
7. Zhou P, Tian J, Li C, Tang Z. Comparative Study of Durability Behaviors of Thermoplastic Polypropylene and Thermosetting Epoxy Exposed to Elevated Temperature, Water Immersion and Sustained Bending Loading. Polymers. 2022;14(14):2953. doi:10.3390/polym14142953
8. Seger EW, McClure SP, Neill BC, Jibbe A. Fast absorbing gut sutures in dermatologic surgery: a systematic review and meta-analysis. Arch Dermatol Res. 2024;316(7):1-7. doi:10.1007/s00403-024-02973-7
9. Jenkins LE, Davis LS. Comprehensive Review of Tissue Adhesives. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2018;44(11):1367-1372. doi:10.1097/DSS.0000000000001576
11. Aboul-Fettouh N, Marzolf S, Smith JM, Srivastava D, Nijhawan RI. Patient satisfaction and preference for absorbable versus nonabsorbable sutures for linear repairs. J Am Acad Dermatol. 2018;79(3):561-562. doi:10.1016/j.jaad.2018.02.020
12. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds - PubMed. Accessed March 17, 2025. https://pubmed.ncbi.nlm.nih.gov/14623686/
13. Moran B, Humphrey S, Seal A, Berkowitz J, Zloty D. Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: A randomized clinical trial. J Am Acad Dermatol. 2020;83(5):1395-1399. doi:10.1016/j.jaad.2020.06.016
14. Rosenzweig LB, Abdelmalek M, Ho J, Hruza GJ. Equal cosmetic outcomes with 5-0 poliglecaprone-25 versus 6-0 polypropylene for superficial closures. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2010;36(7):1126-1129. doi:10.1111/j.1524-4725.2010.01594.x
15. Eisen DB, Zhuang AR, Hasan A, Sharon VR, Bang H, Crispin MK. 5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial. Arch Dermatol Res. 2020;312(3):179-185. doi:10.1007/s00403-019-02009-5
16. Majd A, Lim C, Zloty D. Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2022;48(12):1289-1293. doi:10.1097/DSS.0000000000003625
17. Kim J, Singh Maan H, Cool AJ, Hanlon AM, Leffell DJ. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery. J Clin Aesthetic Dermatol. 2015;8(2):24-29.
18. Sniezek PJ, Walling HW, DeBloom JR, et al. A randomized controlled trial of high-viscosity 2-octyl cyanoacrylate tissue adhesive versus sutures in repairing facial wounds following Mohs micrographic surgery. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2007;33(8):966-971. doi:10.1111/j.1524-4725.2007.33199.x
19. Kwapnoski Z, Doost MS, Vy M, Eisen DB. Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol. 2024;90(3):577-584. doi:10.1016/j.jaad.2023.10.028
20. Handschel JGK, Depprich RA, Dirksen D, Runte C, Zimmermann A, Kübler NR. A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds. Int J Oral Maxillofac Surg. 2006;35(4):318-323. doi:10.1016/j.ijom.2005.10.003
21. Zhuang AR, Beroukhim K, Armstrong AW, Sivamani RK, Eisen DB. Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2020;46(5):628-634. doi:10.1097/DSS.0000000000002076
22. Bartenstein DW, Cummins DL, Rogers GS. A Prospective, Randomized, Single-Blind Study Comparing Cyanoacrylate Adhesives to Sutures for Wound Closure in Skin Cancer Patients. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2017;43(11):1371-1378. doi:10.1097/DSS.0000000000001200
23. Toriumi DM, O’Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg. 1998;102(6):2209-2219. doi:10.1097/00006534-199811000-00062
24. Saxena A, Dubey M, Saha GK, Tiwari D, Tyagi S, Singh RA. A Prospective Comparison of Octyl-2-Cyanoacrylate and Suture in Facial Wounds. J Pharm Bioallied Sci. 2023;15(Suppl 2):S1145-S1148. doi:10.4103/jpbs.jpbs_187_23
25. Balkawade R, Asnani U, Natarajan S, Baviskar P, Ahuja S, Patkar N. Comparative Evaluation of the Aesthetic Outcomes of Octyl-2-Cyanoacrylate Skin Adhesive and Ethilon Suture in Maxillofacial Surgery - A Randomised Clinical Study. Ann Maxillofac Surg. 2024;14(1):10-14. doi:10.4103/ams.ams_182_23
26. Tierney EP, Moy RL, Kouba DJ. Rapid absorbing gut suture versus 2-octylethylcyanoacrylate tissue adhesive in the epidermal closure of linear repairs. J Drugs Dermatol JDD. 2009;8(2):115-119.
27. Bernard L, Doyle J, Friedlander SF, Eichenfield LF, Gibbs NF, Cunningham BB. A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents. Arch Dermatol. 2001;137(9):1177-1180. doi:10.1001/archderm.137.9.1177
28. Fosko SW, Heap D. Surgical pearl: an economical means of skin closure with absorbable suture. J Am Acad Dermatol. 1998;39(2 Pt 1):248-250. doi:10.1016/s0190-9622(98)70084-2
29. Walkosak CC, Jennings T, Coriell P, et al. Infection rate using tissue adhesive versus suture for epidermal closure in dermatologic surgery: A retrospective cohort study. J Am Acad Dermatol. 2025;92(3):579-582. doi:10.1016/j.jaad.2024.10.039
30. Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives. Accessed March 17, 2025. https://onlinelibrary.wiley.com/doi/10.1111/j.1742-4801.2005.00130.x