Topical tissue adhesive versus subcuticular suturing in minimally invasive spine surgery a randomized paired incision trial

Abstract Skin closure technique may influence wound healing, cosmetic outcomes, and operative efficiency in minimally invasive spine surgery (MISS). This prospective assessor- and patient-blinded randomized controlled trial compared topical tissue adhesive with subcuticular suturing using a within-patient paired-incision design. Sixty patients undergoing MISS with bilateral paramedian incisions were enrolled. In each patient, one incision was randomly assigned to topical tissue adhesive and the contralateral incision to subcuticular suturing. Scar outcomes were evaluated using the Vancouver scar scale, patient and observer scar assessment scale, and patient satisfaction scores. Objective scar characteristics were assessed at 12 months using three-dimensional optical imaging. No statistically significant differences were observed in scar outcomes between groups at any follow-up time point. Objective scar parameters at 12 months also showed no statistically significant differences. Wound-related complications were rare and did not differ statistically between groups (1/60 vs. 0/60). Wound-closure time was significantly shorter with topical tissue adhesive (171.1 ± 22.4 s vs. 347.5 ± 92.5 s, p < 0.001). Topical tissue adhesive improved procedural efficiency, while no statistically significant differences were observed in cosmetic or wound-related outcomes compared with subcuticular suturing in MISS.