A Randomized, Controlled Study of Octyl-2-cyanoacrylate and Adhesive Mesh Closure System Versus Subcuticular Suture Closure in Reduction Mammoplasty
James C. Lee, MD, Sherene Ishtihar, BS, Jessica J. Means, BS, June Wu, MD, Christine H. Rohde, MD, MPH.
Columbia University Medical Center, New York, NY, USA.
BACKGROUND: An ideal wound closure system is one that is effective, consistent, and efficient. The commonly-used subcuticular suture is time-consuming, operator-dependent, and inflammatory in nature. Recent studies have demonstrated the efficacy of octyl-2-cyanoacrylate and mesh system (Dermabond Prineo, Ethicon, Inc.) in the closure of surgical wounds. This study compared the use of Prineo to subcuticular suture closure in patients undergoing reduction mammoplasty.
METHODS: A prospective, randomized, controlled, single-blind study of patients undergoing bilateral reduction mammoplasty was performed. Power analysis was done to determine the minimum sample size of seven breasts per group. Each breast per patient was randomized to layered closure with Prineo or subcuticular sutures for the final layer. The incision length and time to closure were measured and recorded for each breast. Incisions were assessed at 2 weeks, 6 weeks, 6 months, and 1 year for scar quality and complications. Subjects completed the Patient Observer Scar Assessment Scale (POSAS) for each breast and two blinded plastic surgeons evaluated scar quality using the Vancouver Scar Scale (VSS) at each time point.
RESULTS: Twenty-one patients participated in the study. On average, Prineo closure took 58.38 seconds (2.50 s/cm) while subcuticular closure took 444.76 seconds (18.94 s/cm). Prineo closure was approximately 6.8 times faster (p=0.000) than subcuticular closure, saving an average of 6.4 minutes per incision. VSS scores were significantly better in patients with Prineo closure at 2 weeks (p=0.026), although there was no difference in POSAS and VSS scores at all other time points. No differences were found in wound complication or infection rates between the two groups and no adverse reactions were observed in either group. Cost analysis of our results estimated an average cost saving of approximately $95 per surgery when Prineo was used instead of subcuticular suture.
CONCLUSIONS: In reduction mammoplasty, Prineo closure results in equivalent scar quality and lower operative cost without increased complications when compared to subcuticular closure. The Prineo system is significantly faster than subcuticular closure and represents an effective, consistent, and efficient alternative to standard suture techniques. 
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