THE WOUND REPAIR OF LACERATIONS NURSING ESSAY   (PT2)             1700w

While cosmesis is considered an important outcome for both patients and health care providers, other measures should be considered before selecting TA as an appropriate alternative to sutures and other SWC methods. The WES type of scoring assessment is necessary and helps provide the right type of treatment as required. Evidence based practice for recommendations in scar therapy is limited (Mustoe, et al, 2020, p.560).

Of the 11 studies Farion, et al, (2017) states that within the studies two different types of TA were used, both of which reporting similar outcomes, with five butylcyanoacrylate (Histoacryl TM) (Barnett 1998; Goktas 2019; Quinn 1997; Schultz 1979; Simon 1997) and six with octylcyanoacrylate (Dermabond TM) (Bruns 1998; Holger 2014; Mattick 2012; Quinn 1998a; Singer 1998; Zempsky

2001). The standard wound closure method was sutures, appearing in seven studies (Barnett 1998; Goktas 2002; Holger 2004; Quinn 1997; Schultz 1979; Simon 1997), adhesive strips in two studies (Zempsky 2001; Mattick 2002), and a mixture of closure methods in the remaining two studies (Bruns 1998; Singer 1998), though the majority of participants received sutures. In one of the studies comparing tissue adhesive with sutures (Holger 2004), the tissue adhesive was actually compared with two types of suture (i.e., absorbable and non-absorbable).

The procedure time and pain score were reported to be as favourable towards TA with little or no difference in the cosmetic appearance. Many studies including Quinn, et al, 1998, p.1528, report using a visual analog scale (VAS) system for recording pain experienced by the patients. This is very similar to the CVAS and WES systems in that zero is recorded as no pain and a score of 100 is recorded as the worst pain possible. Based upon the (Bernard, et al, 2001) study, TA has demonstrated that it may not be as effective in achieving optimal cosmesis for lacerations that are generally under greater tension. These would normally be closed with 3-0 or 4-0 sutures. The application of TA is faster th