Tissue Adhesive Versus Sutures in Oral Biopsy Closure

Official title

Comparison of Tissue Adhesive and Surgical Sutures for Wound Closure After Oral Excisional Biopsies: A Randomized Controlled Clinical Trial

Overview

Excisional biopsies are commonly performed in the oral mucosa, and proper wound closure and hemostasis are critical for the success of the surgical procedure. Suturing remains the gold standard for closing surgical incisions; however, it has several drawbacks, including being time-consuming and requiring technical skill for proper placement. In addition, access to posterior areas of the oral cavity can be challenging. Suturing may also cause patient discomfort during needle penetration of tissues and can serve as a potential pathway for microbial contamination. Therefore, this randomized controlled clinical trial aims to evaluate one of the latest tissue adhesives from the cyanoacrylate group (PeriAcryl 90 HV) compared to conventional surgical sutures (Nylon 4-0) for wound closure following oral excisional biopsies. A total of 28 patients with oral fibroma will be randomly assigned to either the tissue adhesive group or the suture group (14 patients per group).

Detailed description

Appropriate closure of the surgical wound is essential for achieving successful surgical outcomes and optimal wound healing. Although sutures are the most commonly used method for closing wounds in the oral mucosa, they may cause discomfort to patients, particularly in the buccal and labial mucosa. Furthermore, sutures require a second clinical visit for removal. These limitations highlight the clinical need for an alternative to conventional sutures that is easy to apply, does not require removal, and minimizes patient discomfort. This study will compare tissue adhesive (PeriAcryl 90 HV) versus surgical sutures (Nylon 4-0) for wound closure after oral fibroma excision in a randomized controlled trial design.

Interventions

• Device Tissue adhesive (PeriAcryl 90 HV)
  After excisional biopsy of oral fibroma and achieving hemostasis by applying pressure with saline-soaked gauze, the wound surface will be gently dried. PeriAcryl 90 HV (high viscosity butyl cyanoacrylate) will be applied directly using a pipette to cover the entire wound surface . A second layer will be applied 10-15 seconds after the first layer to ensure adequate thickness and durability. The adhesive will polymerize upon contact with moist tissue within approximately 10-20 seconds.
• Device Surgical suture (Nylon 4-0)
  After excisional biopsy of oral fibroma and achieving hemostasis, the wound margins will be approximated using tissue forceps. Interrupted sutures using Nylon 4-0 will be placed to close the wound. Sutures will be removed on day 7 postoperatively.

Primary outcome measures

• Early Wound Healing Score (EHS) [Time frame: Assessed at day 7 and day 14 postoperatively.]
• Operative time (minutes) [Time frame: Measured intraoperatively using a stopwatch.]

Secondary outcome measures (1)

• Postoperative pain measured by Visual Analogue Scale (VAS) [Time frame: Measured at 24 hours, 3 days, and 7 days postoperatively.]

Eligibility criteria

Inclusion criteria

-Patients clinically diagnosed with oral fibroma located on the

labial mucosa (lip) or buccal mucosa (cheek).

• Lesion requires excisional biopsy.
• Lesion size greater than 3 mm and less than 3 cm in

greatest diameter.

Exclusion criteria

• Pregnant or breastfeeding women.
• Patients taking anticoagulant medications (blood thinners).
• Patients with infectious diseases such as hepatitis, HIV, etc.
• Patients taking immunosuppressants.
• Patients with uncontrolled diabetes mellitus.
• Patients taking medications that affect bleeding and wound healing.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Syria · 1 center

• Damascus University ,Department of Oral Medicine, Faculty of Dentistry — Damascus

Publications

• Gogulanathan M, Elavenil P, Gnanam A, Raja VB. Evaluation of fibrin sealant as a wound closure agent in mandibular third molar surgery--a prospective, randomized controlled clinical trial. Int J Oral Maxillofac Surg. 2015 Jul;44(7):871-5. doi: 10.1016/j.ijom.2015.02.001. Epub 2015 Feb 23. PMID 25721919
• Medeiros I, Pascoal S, Castro F, Macedo JP, Lopes O, Pereira J. Tissue adhesives for closure of intraoral surgical incisions: A systematic review and meta-analysis. Int Wound J. 2024 Oct;21(10):e70047. doi: 10.1111/iwj.70047. PMID 39376068
• Oladega AA, James O, Adeyemo WL. Cyanoacrylate tissue adhesive or silk suture for closure of surgical wound following removal of an impacted mandibular third molar: A randomized controlled study. J Craniomaxillofac Surg. 2019 Jan;47(1):93-98. doi: 10.1016/j.jcms.2018.10.018. Epub 2018 Nov 12. PMID 30501926
• Marini L, Rojas MA, Sahrmann P, Aghazada R, Pilloni A. Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds. J Periodontal Implant Sci. 2018 Oct 24;48(5):274-283. doi: 10.5051/jpis.2018.48.5.274. eCollection 2018 Oct. PMID 30405935
• Suthar P, Shah S, Waknis P, Limaye G, Saha A, Sathe P. Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate. J Korean Assoc Oral Maxillofac Surg. 2020 Feb;46(1):28-35. doi: 10.5125/jkaoms.2020.46.1.28. Epub 2020 Feb 26. PMID 32158678
• Rezende ML, Cunha Pde O, Damante CA, Santana AC, Greghi SL, Zangrando MS. Cyanoacrylate Adhesive as an Alternative Tool for Membrane Fixation in Guided Tissue Regeneration. J Contemp Dent Pract. 2015 Jun 1;16(6):512-8. doi: 10.5005/jp-journals-10024-1714. PMID 26323456
• Akhter J, Kalita S, Goyal R, Jaiswal P, Ramalingam K, Yadav D. A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study. Cureus. 2023 Jul 16;15(7):e41973. doi: 10.7759/cureus.41973. eCollection 2023 Jul. PMID 37593271
• Ludlow JB, Kutcher MJ, Samuelson A. Intraoral digital imaging documenting recurrent aphthous ulcer healing in 2-octyl cyanoacrylate versus sham-treated lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Apr;89(4):425-31. doi: 10.1016/s1079-2104(00)70123-5. PMID 10760725

Identifiers

NCT: NCT07654166 · DN- 230226-649

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗