Twenty-six RCTs were included in the review and included 2,105 patients (range 14 to 209) and 2,637 wounds. Nineteen trials (18 according to the table) were of high quality and seven (eight according to the table) were of low quality.
Time for wound closure (19 RCTs): Sixteen RCTs compared tissue glue with skin sutures and fourteen showed faster skin closure using tissue glue. Three of four RCTs that compared tissue glue with skin clips showed faster closure using skin clips. One RCT compared tissue glue with adhesive tape and showed no statistically significant difference in skin closure.
Wound infection (23 RCTs): Rates of wound infection were low. No statistically significant differences were found between tissue glue and standard wound closure (10 estimable RCTs). There was no evidence of statistical heterogeneity (I2=0%).
Subgroup analyses according to trial quality, standard wound closure type, type of tissue glue used and type of operation (where this was calculable) did not significantly alter the findings.
Wound dehiscence (20 RCTs): Dehiscence rates were low, but meta-analysis showed a statistically significantly increased rate of dehiscence in patients who received tissue glue (RR 3.29, 95% CI 1.77 to 6.15, I2=14%; 10 estimable RCTs). Funnel plot analysis showed one outlying trial; removal of this trial did not significantly alter the results.
Subgroup analyses that compared tissue glue with interrupted sutures resulted in no significant differences. Type of glue (2-octyl-cyanoacrylate) affected the results and when one outlying trial was removed the difference became significant.
Eight of 12 RCTs that assessed patient satisfaction reported greater satisfaction with tissue glue. Cosmetic outcomes were reported in the review.