Comparison of 2 Methods of Incision Closure in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery

Leilei Xu, PhD; Feng Zhu, MD; Zezhang Zhu, MD; Zhen Liu, MD; Xu Sun, MD; Jun Qiao, PhD; Saihu Mao, MD; Yong Qiu, MD


Spine. 2014;39(8):E481-E485. 

In This Article

Abstract and Introduction


Study Design. A prospective, randomized, and controlled clinical trial.

Objective. To compare surgical zipper with subcuticular Monocryl sutures in terms of incision closure time, cosmetic results, and the complication rate in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) surgery.

Summary of Background Data. In previous literatures, the application of surgical zipper to incision closure has been reported to be associated with a favorable outcome. However, in the PSF surgery of patients with AIS, the use of surgical zipper has not been described.

Methods. Ninety female patients with AIS undergoing PSF were assigned randomly to 2 incision closure groups either using surgical zipper or using the 4-0 absorbable subcuticular suture. The incision outcome was evaluated with the Hollander Incision Evaluation Score at 7 days, 2 weeks, 6 months, and 1 year after surgery, respectively. Besides, a visual analogue scale was allocated to each patient to rate the cosmetic result of the incision. The 2 groups were compared to determine the differences in terms of incision closure time, the complication rate, and cosmetic results.

Results. The incision closure using surgical zipper consumed significantly less time than that using subcuticular suture (45.3 vs. 540.5 s, P < 0.001). As for the cosmetic results, no significant differences of Hollander Incision Evaluation Score scores between the 2 suturing groups were found. Besides, patients' satisfaction with cosmetic outcome on a linear visual analogue scale also revealed similar results between the 2 groups. As for postoperative complications, we found 1 case of mild blister due to allergy to the tape of the dressings and 2 cases of incisional pain in the Monocryl suture group.

Conclusion. The application of surgical zipper in PSF surgery is a safe and effective method. The ease and the speed of application make surgical zipper an attractive option for incision closure in patients with AIS undergoing PSF.

Level of Evidence: 4


As a primary surgical modality for patients with adolescent idiopathic scoliosis (AIS),[1,2] posterior spinal fusion (PSF) routinely starts with a long skin incision in the back. Ideally, the incision closure after PSF should be safe and effective in terms of time to heal and a favorable appearance of the scar. To date, different types of incision closure techniques have been applied to clinical practice, including synthetic sutures, absorbable sutures, tapes, and adhesive compounds.[3–5] Recently, a new closure technique named surgical zipper is being widely used to facilitate the incision healing.[6–8] This noninvasive closure system allows a homogeneous distribution of stress bilaterally across the entire incision region, thus facilitating a natural healing process of the incision.[6–8] Other advantages of surgical zipper include ease of use, painless application, rapid closure, and the avoidance of needle stick injuries.[9,10] In previous literatures, the surgical zipper has been reported to produce a favorable outcome for incision closure in a wide spectrum of surgical areas including oncology surgery, orthopedic trauma surgery, and urological surgery.[7–9] As for correction surgery of patients with AIS, however, the use of surgical zipper has never been described.

To evaluate the effect of surgical zipper on the incision closure and healing in patients with AIS undergoing PSF, a randomized and controlled clinical study was prospectively performed. This study was designed to compare surgical zipper with subcuticular Monocryl sutures in terms of incision closure time, cosmetic results, and related complications.