Light-activated tissue bonding for excisional wound closure: a split-lesion clinical trial

Background Apposition of wound edges by sutures provides a temporary scaffold and tension support for healing. We have developed a novel tissue-sealing technology, photoactivated tissue bonding (PTB), which immediately crosslinks proteins between tissue planes, thereby sealing on a molecular scale. Objectives To determine the effectiveness of PTB for superficial closure of skin excisions and to compare the results with standard epidermal suturing. Methods A split-lesion, paired comparison study of 31 skin excisions was performed. Following deep closure with absorbable sutures, one-half of each wound was superficially closed with nonabsorbable nylon sutures while the other half was stained with Rose Bengal dye and treated with green light. Overall appearance and scar characteristics were rated at 2 weeks and 6 months in a blinded manner by three dermatologists viewing photographs, by two onsite physicians and by patients. Results At 2 weeks, neither sutured nor PTB-treated segments showed dehiscence; however, PTB-sealed segments showed less erythema than sutured segments as determined by photographic (P = 0·001) and onsite evaluations (P = 0·005). Overall appearance after PTB was judged better than after sutures (P = 0·002). At 6 months, scars produced by PTB were deemed superior to scars resulting from sutures in terms of appearance (P < 0·001), width (P = 0·002) and healing (P = 0·003). Patients were more satisfied with the appearance of the PTB-sealed wound half after 2 weeks and 6 months (P = 0·013 and P = 0·003, respectively). Conclusions A novel molecular suturing technique produces effective wound sealing and less scarring than closure with nylon interrupted epidermal sutures. Comparisons with better suturing techniques are warranted.