Ask an answerable question (PICO)：
Malignant tumors were the number one leading cause of death in Taiwan, especially for breast cancer, which ranks the fourth among the ten leading mortality factors in women. The treatment is usually surgery, and thus, the postoperative care on incision and sutures must be carefully planned to prevent infection and present a certain level of aesthetics. At present, tissue adhesive, such as 2-Octyl Cyanoacrylate (OCA) is the choice in clinical practice, which utilizes the process of polymerization to produce a quick-acting binding effect to form a waterproof and antibacterial protective film on the incision site. This will not only reduce the need of wound dressing but also minimize the risk of infection, when compared with the traditional approach by sutures. The method is also simple and more convenient to care for, as well as giving a better appearance of the “scar”. This is often a question that a patient may ask before surgery, “can tissue adhesive really prevent wound infection?”. This paper would attempt to answer the prevention of postoperative infection by tissue adhesive through empirical study and to find out its effectiveness and benefits from meta-analysis. It is hoped that this paper would provide patient as a reference to clarify some issues in clinical practice.
The Method and Analysis of Literature Review：
Use PICO and MeSH term methods to find synonyms and related words, and use Boolean logic to search Airiti Library Huayi Online Library, CINAHL Plus with Based on the PICO model of exploring the subject on the preventive effectiveness of infection by tissue adhesive (2-Octyl Cyanoacrylate) in patients after breast cancer surgery, we would use MeSH terms, synonyms and natural words with Boolean logics of OR and AND to set the Chinese and English keywords of "breast cancer surgery", "tissue adhesive" and "sutures”, which would be used to search the Chinese and English database of Airiti Onlnie Library, CINAHL Plus with Full Text, Cochrane Library and PubMED. The types of inquiry were limited to documents of meta-analysis and systematic literature review, involving random controlled trial studies. A total of 136 articles were found, excluding inconsistent and repeated documents, from which three random controlled trial studies were included for evaluation.
Critical Appraisal：
In this paper, the CASP checklist of year 2020 for random controlled trial study was used as the evaluation tool to further analyze the literatures in terms of effectiveness, significance, and application. The purpose of reviewing the three literatures was to compare the postoperative treatment for patients of breast cancer, where the experimental groups would all use tissue adhesive, while the control groups received suturing. The documents were carefully reviewed and underwent meta-analysis by using RevMan 5.3 software. The results showed no difference of statistical significance in terms of infection rate and aesthetic satisfaction. However, the rate of wound dehiscence increased dramatically with tissue adhesive. Furthermore, one of the studies showed the cost of care for patients using tissue adhesive was significantly lower than ones using suturing, besides that patients in one of the literatures reported significantly more comfort in using tissue adhesive. All three literatures were classified as Level 2 in Oxford’s CEBM in 2011.
Results, Conclusions and Recommendations：
The general literature review of three randomized control trials revealed that the use of tissue adhesive (2-Octyl Cyanoacrylate) could not significantly prevent infection and increase aesthetic satisfaction in patients of breast cancer after surgery, and instead, it might increase the chance of wound dehiscence, even though one study did show that the use of tissue adhesive was more comfortable and cost less in postoperative care.
In response to the aforementioned clinical situation in this paper, it is recommended that professional nurse should take into account of the empirical status of the patient at the moment to discuss and reach a consensus with the medical team, as well as serving as a bridge between the patient and medical staff in a mode of shared decision making (SDM), where the family members will learn to select the most appropriate wound dressing based on their own economic status or needs. The use of tissue adhesive (2-Octyl Cyanoacrylate) after surgery should also be evaluated along with the changes in wound for its necessity and relevant knowledge and skills in caring the patient will be taught to the family members, as to not only prevent infection and unexpected wound dehiscence, but also significantly reduce any tangible cost on manpower for changing the dressing, which will surely help to improve patient’s comfort and overall satisfaction.
