Does the Zip-type Closure Device Yield Greater Scar Cosmesis than Traditional Closure Techniques for Surgical Incisions?

OBJECTIVE: The objective of this systematic evidence-based medicine review is to determine whether or not the zip skin closure device yields greater scar cosmesis outcomes than traditional closure techniques. STUDY DESIGN: Systematic review of two randomized controlled trials published in 2016 and one non-randomized control trial published in 2017. DATA SOURCES: All articles were published between 2016-2017 in the English language including human based surgical scars and excluding laparoscopic scars and animal studies. All articles were obtained through PubMed. OUTCOMES MEASURED: Outcomes were measured based on scar photographs and in-person scar evaluation. A blinded panel of board-certified plastic surgeons were used in two studies, utilizing a 100-mm-long horizontal scale CVAS (cosmetic visual analogue scale) and a Vancouver Scar Scale (VSS). Performing surgeons rated the scars using WES (wound evaluation score), Likert-type 5-point scale, and a variation of VSS. Patients rated the scar in one study using the Likert-type 5-point scale. All surgical scar cosmesis outcomes were compared at 3 months post-operation among all studies. RESULTS: The study by Lalani et al. (Pacing Clin Electrophysiol. 2016 Oct; 39(10):1077-1082. doi: 10.1111/pace.12926) showed comparable results between the zip device and sutures in median sternotomies of the adult population. The study by Takana et al. (Ann Thorac Surg. 2016; 102(4):1368-1374. Doi: 10.1016/j.athoracsur.2016.03.072.) showed significantly better cosmetic results using the zip closure device than sutures in pediatric cardiothoracic surgery. In the adult population, a study (Ko JH, Yang IH, Ko MS, Kamolhuja E, Park KK. Int Wound J. 2017;14(1):250-254. doi: 10.1111/iwj.12596.) showed significantly better cosmetic results using the zip-device than staples in total knee arthroscopy. CONCLUSIONS: The zip device offers comparable if not better cosmesis results compared to traditional closure techniques. Allergic reaction and epidermolysis are a potential side effect of the adhesive and should be considered when applying the device. Otherwise, the zip device is a time saving device that could offer comparable or superior results to sutures or staples in children and adults