Tissue Adhesive Versus Sutures for Skin Closure in Primary Cleft Lip Repair: A Systematic Review and Meta-Analysis

<i>Objective</i>To evaluate the effectiveness of cyanoacrylate tissue adhesives versus conventional sutures for skin closure in primary cleft lip repair, focusing on esthetic, clinical, and patient-centered outcomes.<i>Design</i>Systematic review and meta-analysis of randomized controlled trials and comparative observational studies.<i>Setting</i>Multicenter data synthesis including studies from the United States, the United Kingdom, India, Nigeria, and the Netherlands.<i>Patients, Participants</i>A total of 442 patients undergoing primary cleft lip repair, with 402 contributing extractable outcome data.<i>Interventions</i>Epidermal closure using tissue adhesives (octyl-2-cyanoacrylate, iso-amyl cyanoacrylate, or octyl-2-cyanoacrylate with polyester mesh tape) compared with fine nonabsorbable sutures (nylon, Prolene, or Monocryl).<i>Main Outcome Measure(s)</i>Esthetic scar quality, wound complications, parental satisfaction, operative time, and scar-related secondary parameters (eg, white roll alignment, hypertrophic scarring).<i>Results</i>Eight studies met inclusion criteria, of which 2 were randomized controlled trials. Meta-analysis showed no significant difference in esthetic outcomes between adhesives and sutures (SMD -0.05, 95 % confidence interval [95% CI] [-0.28 to 0.18]; I² = 12%). Complication rates were comparable (RR 0.93, 95% CI [0.41-2.11]). Operative time was consistently shorter with adhesives, reducing closure by 5 to 7 min per case. Parental satisfaction was uniformly higher in adhesive groups. Evidence certainty was graded moderate for esthetic outcomes and wound complications, and low for operative time and satisfaction.<i>Conclusions</i>Tissue adhesives provide equivalent esthetic and complication outcomes to sutures in cleft lip repair, with added advantages of faster closure and improved parental satisfaction. Incorporating adhesives into cleft protocols may enhance efficiency and patient-centered care, though further high-quality trials with long-term follow-up are warranted.