***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There is long-st and ing disagreement among facial plastic surgeons as to the ideal suture material for closing skin wounds of the face . Many surgeons believe that nonabsorbable suture material is preferable , as it is easier to tie , is unlikely to break prematurely , and elicits a minimal inflammatory response . Others feel that these issues are of minor importance and prefer absorbable sutures because they do not have to be removed , thus saving the surgeon time and decreasing patient anxiety and discomfort . PATIENTS AND METHODS Facial skin cancers were removed from 41 patients . The length of closure ranged from 3.5 to 12.0 cm . All wounds were closed with rotational advancement flaps . Deep tissues were closed with 4 - 0 poliglecaprone 25 ( Monocryl ; Ethicon Inc , Somerville , NJ ) . One half of each wound was r and omly closed with 5 - 0 coated polypropylene ( Prolene ; Ethicon Inc ) , while the other half was closed with 5 - 0 coated irradiated polyglactin 910 ( Vicryl Rapide ; Ethicon Inc ) . No wound infections or premature rupture of sutures occurred . All patients were followed up for 6 months after surgery . The photographs of the results were review ed , and no difference was noted in scar formation . CONCLUSIONS In adults with clean wounds of the face or neck , there is no difference in long-term cosmetic results of repairs with permanent or absorbable suture material . We prefer absorbable sutures , as they do not have to be removed , saving the surgeon time and lessening patient anxiety and discomfort STUDY OBJECTIVE To compare the tissue adhesive Histoacryl Blue with suturing in the repair of pediatric facial lacerations . DESIGN Prospect i ve , r and omized controlled trial . SETTING Emergency department of a pediatric teaching hospital . PARTICIPANTS Eighty-one children presenting with clean facial lacerations less than 4 cm in length and 0.5 cm in width . INTERVENTIONS Patients were allocated r and omly to have their lacerations repaired with sutures or Histoacryl Blue . RESULTS The two groups were similar for demographic and clinical characteristics . Photographs taken at three months were rated by two plastic surgeons blinded to the method of closure . There was no difference between groups for appearance scores on a visual analog scale ( 60.5 mm for Histoacryl Blue versus 57.2 mm for suture , P = .45 ) or on a categorical scale  ( Histoacryl Blue versus sutures : unacceptable , 11 % versus 13 % ; acceptable , 59 % versus 71 % ; excellent , 30 % versus 16 % ; P = .76 ) . Measures of observer agreement produced Pearson correlations of .72 and .94 on the visual analog scale and kappa coefficients of .46 and .73 on the categorical scale . Histoacryl Blue was assessed as less painful on a visual analog scale ( 24.7 versus 43.7 mm , P < .01 ) and faster ( 7.9 versus 15.6 minutes , P < .001 ) . CONCLUSION Histoacryl Blue is a faster and less painful method of facial laceration repair that has cosmetic results similar to the use of sutures STUDY OBJECTIVE More than 11 million patients with traumatic wounds are seen annually in emergency departments . We developed and vali date d a data registry for traumatic wounds treated in the ED . DESIGN Prospect i ve , consecutive patient enrollment with a validation cohort of a convenience sample of 100 patients . SETTING University-affiliated hospital ED . PARTICIPANTS For all patients with traumatic wounds requiring sutures ,  wound registry data sheets were completed at the time of initial visit using a closed- question format . Data recorded included demographic characteristics , time from injury to evaluation , pertinent medical history , wound characteristics , type of anesthesia , details of wound-cleansing methods , details of wound closure , and postoperative care . We devised a follow-up tool to evaluate for the presence of infection and short-term cosmetic appearance . Interphysician reliability was assessed for wound description , presence of infection , and cosmetic appearance by use of the kappa statistic . RESULTS A wound registry data collection instrument that takes less than 1 minute to complete and enables the collection of most wound management techniques used by emergency physicians was found to have substantial interobserver concordance for wound description ( kappa range , .55 to .97 ) , wound infection ( kappa = 1.0 ) and overall cosmetic appearance ( kappa = .61 ) . CONCLUSION The wound registry is a reliable data collection instrument that is easy to use . It may be useful as a continuous quality -improvement tool or for st and ardization of wound surveillance and treatment data to facilitate future prospect i ve studies in wound management One hundred and sixty-seven patients undergoing laparotomy  were r and omly allocated to a continuous layered closure technique with absorbable monofilament polyglyconate ( PG ) ( Maxon * ) or non-absorbable polyamide ( PA ) ( Ethilon * ) . Laparotomy wounds were closely observed during the postoperative hospital course and all patients were review ed at one month , six months and one year . Any wound complications were noted . Two patients in the PA group ( 3.0 % ) presented with burst abdomen and one ( 1.9 % ) in the PG group ( ns ) . The incidence of incisional hernia was not statistically different between the two groups ( 4/64 , 6.0 % in PA group and 4/65 , 6.2 % in PG group ) . The postoperative wound infection rate was 21.0 % in the Pa group and 15.4 % in the PG group ( ns ) . The present study clearly shows a major increase in incidence of wound failure in patients with infected abdominal wounds in both groups ( 28.6 % vs 3.8 % in PA group p less than 0.025 ; 20 % vs 5.5 % in Pg group p less than 0.05 ) . This clinical trial confirms the important roles of wound infection and respiratory failure in the occurrence of wound failure ; the choice of an absorbable or a non-absorbable suture material seems to play a minor role only This prospect i ve r and omized study included 100 patients with inguinal hernia and 66 patients operated on for acute appendicitis . In half of each group the skin was closed with a continuous subcuticular resorbable suture , and in the other half with a monofilament nylon matress suture . The patients were followed up after three weeks and again after three months . There was no obvious difference in cosmetic result between the two methods of skin closure . In the patients with inguinal hernia or non-perforated appendicitis there was no increase in postoperative infection of the wound after subcuticular suture . In the case of perforated appendicitis there may have been an increase in infection of the wound after subcuticular suture . Continuous , subcuticular resorbable suture used on the right indications can give a good cosmetic result and few complications of the wound . Further more , a separate outpatient visit for removal of skin sutures or staples can be avoided OBJECTIVE To compare histoacryl blue tissue adhesive glue with suturing in the repair of simple paediatric lacerations . METHODOLOGY Prospect i ve , r and omised controlled trial in tertiary paediatric emergency department . Children 4 years old or older with non-ragged lacerations < 5 cm in length , < 12-h-old and not involving eyelid or mucous membrane . A total of 163 patients were r and omly allocated to either glue ( 83 cases ) or sutures ( 80 controls ) to repair their laceration . Primary outcome measures were cosmetic outcome at 3 and 12 months with secondary outcomes -length of time to perform procedure , and pain assessment of procedure by doctor , nurse , parent and child . RESULTS Cases and controls were similar in age , wound length and width and body part involved , but more females received glue ( P = 0.013 ) . Time taken to repair the wound was faster in the glue group ( median 0 - 2 mins vs. 6 - 10 min suture , P<0.001 ) . Doctors ( P = 0.02 ) , nurses ( P<0.01 ) and parents ( P = 0.02 ) but not the children themselves ( P = 0.24 ) rated glue repair as less distressing . Complications at 1 week ( wound dehiscence , redness and discharge ) were the same for both groups ( P>0.2 ) . Cosmetic outcome was the same for both groups at 3 ( n = 65 ) and 12 ( n = 65 ) months ( P>0.7 ) . CONCLUSION Tissue adhesive glue is faster and probably less painful than suturing . Tissue adhesive glue has the same cosmetic result as suturing when used for the repair of simple lacerations in children OBJECTIVE To assess the effectiveness of a new tissue adhesive for laceration closure . DESIGN A prospect i ve , r and omized controlled trial . SETTING An adult teaching hospital . PARTICIPANTS One hundred thirty patients with 136 lacerations who consented to enrollment during a 5-month period . The lacerations included all eligible nonmucosal facial lacerations , as well as selected extremity and torso lacerations ( not on h and s , feet , or joints ) . One hundred six lacerations were available for early follow-up , and 98 were available for 3-month evaluation . INTERVENTIONS Lacerations were r and omly allocated to have skin closure with octylcyanoacrylate adhesive or monofilament suture . MAIN OUTCOME MEASURE A 3-month photograph of the wound was assigned a cosmesis score on a previously vali date d 100-mm visual analog cosmesis scale by a plastic surgeon who was unaware of the method of wound closure . RESULTS There were no differences in the mean visual analog cosmesis scores ( 67 mm for octylcyanoacrylate vs 68 mm for sutures ; P=.65 ) . Similarly , there was no difference in the percentage of early ( 80 % vs 82 % ; P=.80 ) or late ( 72 % vs 75 % ; P=.74 ) optimal wound evaluation scores . The tissue adhesive was a faster method of wound repair ( 3.6 vs 12.4 minutes ; P<.001 ) as well as being less painful ( visual analog pain scores , 7.2 vs 18.0 mm ; P<.001 ) . CONCLUSIONS Octylcyanoacrylate tissue adhesive effectively closes selected lacerations . This relatively painless and fast method of wound repair can replace the need for suturing several million lacerations each year One hundred and four patients with superficial lacerations were sutured with either Dexon ( polyglycolic acid ) , silk , polyethylene or nylon sutures . The incidence of postoperative tissue reaction and wound infection was compared Nylon vertical mattress sutures and interrupted subcuticular polydioxanone ( PDS ) sutures have been used for skin closure . The complications and cosmetic results of each have been noted in a prospect i ve trial of 93 hip wounds . When nylon sutures are used there is an increased incidence of erythema and the final scar is less cosmetically attractive . Interrupted PDS sutures take longer to insert but have few complications and are recommended in both the young and elderly patients The objective of this study was to compare the 9- to 12-month cosmetic outcome of facial lacerations closed with rapid-absorbing gut suture ( RG ) , octylcyanoacrylate ( OC ) , or nylon suture ( NL ) . We hypothesized that no important differences would exist between these methods . This prospect i ve , r and omized study enrolled consecutive patients with facial lacerations when experienced physician assistants were on duty for wound closure . Patients returned at 9 to 12 months for cosmetic evaluation . Two blinded physicians performed visual analog cosmesis scale ( VACS ) scoring , and the patient completed a VAS satisfaction score .  One hundred forty-five patients were enrolled . Nine-month follow up occurred in 84 patients . The maximum difference within each evaluator 's set of scores was 3.6 mm , well below the minimum clinical ly important difference ( MCID ) of 10 to 15 mm . We did not detect clinical ly important differences in cosmetic outcome at 9 to 12 months in patients with facial lacerations closed with RG , OC , or NL , although RG or OC could be preferred to eliminate follow-up visits for suture removal To develop an appearance scale that will allow the objective and scientific comparison of the cosmetic results of healed lacerations , 33 photographs of healed lacerations and incisions with variable cosmetic results were shown to four plastic surgeons . These plastic surgeons were asked to independently rate the photographs on two separate occasions using two scales , a Visual Analogue Scale and a Categorical Scale . Interobserver and intraobserver agreement were determined for each scale . Comparison of the scales with each other was done to assess consistency . The Visual Analogue Scale showed good interobserver agreement with an Intraclass Correlation Coefficient of 0.75 . Intraobserver agreement was also high across the four observers with Pearson correlation coefficients ranging from 0.73 to 0.87 . The agreement of the categorical scale was also good with a kappa coefficient for interobserver agreement of 0.53 . The kappa coefficient for intraobserver agreement ranged from 0.48 to 0.72 . Because the visual analogue scale and categorical scale showed good interobserver and intraobserver agreement , 
    Output:
    
There was no statistically significant difference between absorbable and nonabsorbable sutures in short- or long-term cosmetic score , scar hypertrophy , infection rate , wound dehiscence , and wound redness/swelling .
CONCLUSIONS Our meta- analysis suggests a lack of large , method ologically sound RCTs evaluating the effectiveness of absorbable versus nonabsorbable sutures .