***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 Wound closure devices include sutures , tissue adhesives , adhesive strips , and staples . Recent studies suggest no differences between various tissue adhesives and sutures for dehiscence , infection , and satisfaction when assessed by patients or surgeons . To date , no studies have investigated ClozeX ( Clozex Medical LLC , Wellesley , MA , USA ) , a novel adhesive strip , for closure of surgical incisions . OBJECTIVE To compare surgical wounds repaired with ClozeX versus suture . METHODS A prospect i ve , r and omized study was conducted , in which 15 patients with surgical incisions were allocated to closure with ClozeX on half of the wound and monofilament suture on the other half .  Physician satisfaction with blinded assessment , patient satisfaction , complication rates , and closure times were recorded . RESULTS Application with ClozeX was faster than with suture ( p=.007 ) . There were no complications in either group . Sixty-nine percent of the patients gave ClozeX a higher satisfaction score ( p=.02 ) . More physicians were satisfied with the ClozeX half than with the suture half ( p=.007 ) . CONCLUSIONS This pilot study demonstrates ClozeX to be a safe and effective closure device . The cosmetic outcome seems to be at least as good as simple running suture . Physicians and patients were generally more satisfied with ClozeX. No difference was found in the rate of dehiscence or infection between the groups 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 Acrylate glues used in a childrens ' day care unit to close small surgical wounds were compared . In 157 children , aged 12 weeks to 3.7 years , either Histoacryl or Dermabond was used ( respectively , H : Ethicon Inc. , Johnson & Johnson , NJ or D : Dermabond , Braun Surgical Gmbh , Melsungen , Germany ) . Operations were for inguinal hernia ( 110 cases ) , hydrocele ( 25 ) , undescended testis ( 16 ) , umbilical hernia ( 13 ) and funiculocele ( 3 ) . 1 week after surgery the wounds were evaluated in terms of integrity of closure , redness or infection , need for antibiotics , wound granuloma , and parental satisfaction with instructions and actual method of wound caring . 3 months after surgery the wound/scar was reexamined . The margins of the wounds were separated partially or completely in 8 of 85 in group H ( 9.4 % ) while in the D group , 2 wounds ( 2.4 % ) had partially opened ( p < 0.05 ) . There were no differences between the glues with regard to wound infection or cosmetic results . Parental satisfaction was higher with D ( 96 % ) than H ( 82 % ) but the difference was not statistically significant . It is convenient to use glue to close operative wounds in children after ambulatory surgery . The use of D  significantly reduced wound ruptures compared to H.  Long-term cosmetic results were similar OBJECTIVE To determine the effectiveness of a tissue adhesive , Histoacryl Blue ( HAB ) , for laceration repair in children . DESIGN Prospect i ve , r and omized clinical trial . SETTING A tertiary care pediatric emergency center at Egleston Children 's Hospital . PARTICIPANTS Children who presented for laceration repair between October 1994 and February 1995 were prospect ively evaluated . Patients less than 1 or greater than 18 years of age , those with lacerations greater than 5 cm , and those with lacerations located on the eyelids , ears , nose , lips , h and s , feet , joints , or perineum were excluded . INTERVENTIONS Following consent and routine wound management , including subcutaneous closure when deemed necessary , patients were r and omized to receive skin sutures or HAB for cutaneous closure . METHODS Length of time required for laceration repair was recorded . Parental perception of the pain experienced by their child was assessed using a visual analogue scale . Photographic documentation of scar appearance at the 2-month follow-up visit was evaluated by plastic surgeons using a visual analogue scale . RESULTS Sixty-one children were enrolled :  HAB group ( N = 30 ) , suture group ( N = 31 ) . No differences occurred between groups in laceration length , depth , location , or patient demographics . Length of time required for repair was decreased ( median , HAB 7 minutes vs suture 17.0 minutes ) and parental assessment of their child 's pain was significantly less in the HAB group . Parents were more likely to recommend HAB over suturing to other parents or guardians . Cosmetic outcome in the HAB group was assessed to be as good as , or better than , the cosmetic outcome in the suture group as evaluated by two plastic surgeons . CONCLUSION The use of HAB for laceration repair is an acceptable alternative to conventional suturing with a comparable cosmetic outcome . Advantages include less pain to the child , no need for suture removal , and more efficient use of physician time . Parents were also more likely to recommend HAB over suturing for laceration repair BACKGROUND Surgical site infections ( SSI ) are the most common nosocomial infection in surgical patients , accounting for 38 % of all such infections , and are a significant source of postoperative morbidity result ing in increased hospital length of stay and increased cost . During 1986 - 1996 the Center for Disease Control and Prevention 's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations ( 2.6 % ) . Previous studies have documented patient characteristics associated with an increased risk of SSI , including diabetes , tobacco or steroid use , obesity , malnutrition , and perioperative blood transfusion . In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients . METHODS Prospect i ve data ( NSQIP ) were collected on 5031 noncardiac surgical patients at the Veteran 's Administration Maryl and Healthcare System from 1995 to 2000 . All preoperative risk factors were evaluated as independent predictors of surgical site infection . RESULTS The mean age of the study cohort was 61 plus minus 13 .  SSI occurred in 162 patients , comprising 3.2 % of the study cohort . Gram-positive organisms were the most common bacterial etiology . Multiple logistic regression analysis documented that diabetes ( insulin- and non-insulin-dependent ) , low postoperative hematocrit , weight loss ( within 6 months ) , and ascites were significantly associated with increased SSI . Tobacco use , steroid use , and chronic obstructive pulmonary disease ( COPD ) were not predictors for SSI . CONCLUSION This study confirms that diabetes and malnutrition ( defined as significant weight loss 6 months prior to surgery ) are significant preoperative risk factors for SSI . Postoperative anemia is a significant risk factor for SSI . In contrast to prior analyses , this study has documented that tobacco use , steroid use , and COPD are not independent predictors of SSI . Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition 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 , both may be considered good measurement tools in the comparison of alternate methods of laceration care 
    Output:
    
Sutures were also found to be significantly faster to use .
For all other analyses of infection , patient and operator satisfaction and cost there was no significant difference between sutures and tissue adhesives .
In this same trial tissue adhesives were significantly less time consuming to use .
This trial also compared high viscosity with low viscosity adhesives and found that high viscosity adhesives were less time consuming to use than low viscosity tissue adhesives .
For all other outcomes of dehiscence , infection , patient satisfaction and operator satisfaction there was no statistically significant difference between high and low viscosity adhesives .
Sutures were significantly better than tissue adhesives for minimising dehiscence and were found to be significantly faster to use .