A Band-Aid for a Bullet Hole? – Maybe with microMend

July 12, 2023

Written by Ketan Patel

Spoon Feed
In this very limited study, the microMend* device was found to be comparable to classic repair techniques in terms of wound closure and cosmetic outcome, with high satisfaction among both providers as well as patients, but note the caveats below.

Big bark, small bite
Two emergency departments participated in a single-arm study analyzing wound closures utilizing the mircoMend device in an open-label application.  The study comprised 31 patients, and wounds of various lengths were closed utilizing the microMend device.

The study measured evaluations of wound repair at the time of insertion, at short term with removal, and also at 90 days using a Visual Analog Scale (VAS) of cosmesis as well as a wound evaluation scale (WES). In addition to this, surveys evaluated satisfaction with the device and closure for both providers and patients as well as pain scores for the latter.

Their results and analysis showed that wound outcome was satisfactory, that users thought the device was speedy, easy to use, and cosmesis was regarded as good. Patients also felt device was overall good and caused minimal discomfort.

However, before throwing away the sutures and staples, it is important to note that out of 642 patients, only 31 patients completed the study. Over 90% of these patients didn’t meet their inclusion criteria. In addition, 5 of the devices came off before the anticipated removal date. While there weren’t any adverse outcomes, this is a significant portion.

Also, while having plastic surgeons performing VAS scores at 90 days sets the bar high, having patients and parents judge in a broader study that includes pediatrics would be much more applicable to implementation.

How will this change my practice?
It won’t at the moment. Based on this article, I think microMend would be fantastic to use on a very small number of patients with lacerations. These situations though are very nuanced, and a study addressing kids and broader implementation would be needed to make a significant practice change.

*microMend is a wound closure device with a “dual-action system of gentle, gripping microstaples and cantilever springs.”

Editor’s note: This reminds me of the spoof PARACHUTE RCT in BMJ, in which jumping from a plane with an empty backpack vs a parachute did not increase mortality. Of course, those included jumped from 2 feet up at zero miles per hour – compared to those excluded, who jumped from 30,000 feet at 500 mph. >95% of patients were excluded; they had 5 primary outcomes, 23 exclusion criteria, and no comparator group in this study design, so take it with a grain of salt. ~Clay Smith

Source
Evaluation of microMend wound closure device in repairing skin lacerations. Emerg Med J. 2023 May 23;emermed-2022-212667. doi: 10.1136/emermed-2022-212667. Online ahead of print.