Outcomes of cosmetic suturing versus tissue adhesive for pediatric forehead lacerations: A retrospective cohort study adjusting for injury severity.

PURPOSE: To compare the clinical outcomes of cosmetic layered suturing versus medical tissue adhesive in pediatric forehead lacerations, with specific emphasis on the risk of dynamic expression dimpling and long-term scar quality, after adjusting for baseline wound severity.

METHODS

A retrospective cohort study was conducted on 265 pediatric patients with acute forehead trauma treated between October 2023 and May 2024. Patients were stratified into a Cosmetic Suture Group (n=135) and Tissue Adhesive Group (n=130). A post-hoc power analysis confirmed sample adequacy. Baseline characteristics were analyzed to identify selection bias. The primary outcomes were the incidence of dynamic expression dimpling and 12-month Vancouver Scar Scale (VSS) score. Multivariable regression and sensitivity analyses using propensity score matching (PSM) were performed.

RESULTS

Significant selection bias was observed: the Suture Group managed wounds that were significantly deeper (P<0.001) and longer (P<0.001). Despite treating less severe injuries, the Adhesive Group exhibited a significantly higher incidence of postoperative dynamic expression dimpling (11.5% vs. 3.0%, P=0.007). Sensitivity analysis via PSM confirmed that tissue adhesive was an independent risk factor for expression dimpling (OR=3.92, P=0.029). Regarding long-term scar appearance, linear regression revealed that 12-month VSS scores were predicted by initial wound depth (β=0.312, P<0.001) and the use of postoperative laser therapy (β=-0.205, P=0.001), rather than the closure method itself (P=0.345).

CONCLUSION

Although tissue adhesives offer procedural convenience, they are associated with a quadrupled risk of dynamic expression dimpling compared to suturing, likely owing to inadequate approximation of the underlying frontalis muscle. Layered cosmetic suturing is essential for preventing contour deformities in deep lacerations. Furthermore, postoperative laser therapy is a validated independent factor for optimizing scar outcomes.