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Wound Healing Adjuncts

Wound-healing adjuncts are the products the reconstructive urologist reaches for after the stitch has been placed — tissue adhesives, closure strips, specialty dressings, negative-pressure wound therapy (NPWT), skin substitutes and acellular dermal matrices, platelet-rich plasma and growth factors, and hyperbaric oxygen. Each has a specific indication profile and a specific set of failures; none substitute for adequate debridement, tension-free closure, and attention to perfusion. This article catalogs the options relevant to GU reconstructive practice and the evidence behind each.

See also: Wound healing, Reconstructive ladder, Flaps in GU reconstruction, Grafts in GU reconstruction, Platelet-rich plasma (the pharmacology hub with urethroplasty / Peyronie's / ED detail).

Tissue Adhesives — Cyanoacrylates​

Octyl-2-cyanoacrylate (Dermabond, Ethicon) polymerizes on contact with tissue to form a flexible, water-resistant film over apposed wound edges.[1][2]

PropertyDetail
Best useSmall, superficial, low-tension wounds — lacerations, excisional wounds. Replaces 5-0 or smaller sutures, eliminates the need for removal.[1]
Tensile strengthComparable to 5-0 nonabsorbable suture; film sloughs in ~5 days; inherent antibacterial properties[2]
ContraindicationsHigh-tension areas, mucosal surfaces, poor hemostasis, cyanoacrylate hypersensitivity[2]

Cochrane head-to-head vs sutures​

Dumville 2014 Cochrane (33 studies) — sutures are superior to tissue adhesives for preventing dehiscence (RR 3.35; NNH 43). No difference in infection, cosmesis, or patient satisfaction.[3][4] Cyanoacrylate alone is not an equivalent substitute for subcuticular closure in high-tension wounds.

Dermabond Prineo — cyanoacrylate + polyester mesh​

Kulkarni 2025 meta (12 studies): Prineo combines cyanoacrylate with a polyester mesh that shares tension across the wound:[5]

  • ↓ infection (1.51% vs 2.13%; OR 0.65; p = 0.01)
  • ↓ delayed wound healing
  • Faster closure times
  • A legitimate tension-sharing adhesive option in longer GU incisions where cyanoacrylate alone would fail

Practical GU use​

  • Scrotal and small perineal laceration closure
  • Closure of cosmetic-sensitive meatotomy / small urethrocutaneous incisions under minimal tension
  • Not for midline laparotomy closure, flap fixation, or any tension-bearing GU reconstruction

Adhesive Strips — Steri-Strips​

Steri-Strips (3M) are adhesive tape strips for epidermal approximation, used as an adjunct to buried dermal sutures or as standalone closure of low-tension wounds.[6]

PointData
Custis 2015 RCTAdding Steri-Strips to buried dermal sutures did not improve cosmesis or reduce scar width vs dermal sutures alone[6]
Steri-Strip S (coaptive film)Faster closure (2 vs 4.6 min on breast incisions); comparable complications; slightly worse scar on breast wounds[7]
Practical roleCheap, painless to apply, no needlestick risk. Reasonable for low-tension superficial approximation after buried-suture closure[8]

Skin-Graft Donor-Site Dressings​

The ideal donor-site dressing maintains a moist wound environment, absorbs exudate, minimizes pain, and protects against infection.[9] Directly relevant for STSG and FTSG harvest in phalloplasty, perineal reconstruction, and buried-penis-adult-acquired closure (see Grafts in GU reconstruction).

Brölmann 2013 — the 14-center 6-arm RCT​

Landmark direct comparison of six dressing types for STSG donor sites:[10]

DressingKey finding
Hydrocolloid (DuoDERM)Fastest re-epithelialization — 7 days shorter than all other dressings (median 16 vs 23 days)
Film (Tegaderm, OpSite)Lowest pain scores; patients least satisfied with scar quality
Alginate (Kaltostat)Good exudate absorption; moderate healing time
Hydrofiber (Aquacel)Good moisture management; comparable healing
SiliconeComfortable; comparable healing
GauzeInfection rate twice as high as other dressings (18% vs 7.6%) — should be discontinued as donor-site dressing

Newer options​

  • Polylactic acid membrane (Suprathel) — Moellhoff 2022 RCT: lower Vancouver Scar Scale, less pain during dressing changes, fewer dressing changes; higher material cost[11]
  • Hydrogel — Cochrane 2023: moist environment, possible pain reduction via cooling effect; evidence limited but promising[9]

Bottom line: hydrocolloid for fastest donor-site healing; abandon gauze as a donor-site dressing because of the doubled infection rate.[10]

Negative-Pressure Wound Therapy (NPWT / Wound VAC)​

NPWT applies controlled subatmospheric pressure via a sealed foam or gauze dressing connected to a suction device.[12][13]

Mechanism​

  • Contracts wound edges
  • Removes exudate and inflammatory mediators
  • Promotes angiogenesis and granulation tissue formation
  • Creates a bacterial barrier[13][14]

Evidence​

SourceFinding
Zens 2020 meta (48 RCTs, n = 4,315)↑ wound closure (OR 1.56; p = 0.008); ↓ hospital stay by ~ 5 days vs standard wound therapy[15]
Gu 2025 diabetic foot ulcers87% complete closure with NPWT vs 29% with advanced moist wound therapy; significantly lower infection, recurrence, and amputation rates[16]
Norman 2022 Cochrane (primary-closure surgical wounds)Closed-incision NPWT reduces SSI and dehiscence in high-risk wounds[14]

Applications for the reconstructive urologist​

ScenarioRole of NPWT
Fournier's gangrene post-debridementBridge to definitive closure or skin grafting; reduces dressing changes; promotes granulation[13]
Perineal / scrotal wound dehiscenceAccelerates granulation; reduces serous drainage
Diabetic peripelvic/perineal ulcersStrong DFU-literature signal extrapolates[16]
Closed-incision NPWT (ciNPWT / Prevena) over primarily closed high-risk incisionsCystectomy / complex pelvic reconstruction patients with obesity, diabetes, radiation, prior failed closures[12]
NPWTi-d (instillation therapy)Intermittent topical solution delivery under negative pressure; reduces the number of operative debridements in grossly infected or soiled wounds[12]

Skin Substitutes & Acellular Dermal Matrices​

Classified as cellular, acellular, and matrix-like products (CAMPs).[17][18]

Acellular dermal matrices (ADMs)​

Provide a collagen scaffold for cellular ingrowth without living cells.

ProductSourceGU-relevant use
IntegraBovine collagen + glycosaminoglycansMost-studied dermal regeneration template — full-thickness burns, scalp reconstruction, complex wounds with exposed bone or tendon. Requires two-stage procedure (template placement → thin autograft)[19][20]
AlloDermHuman cadaveric acellular dermisBreast reconstruction, abdominal-wall repair, head/neck reconstruction — by extension, pelvic-floor / perineal reconstruction with tissue deficit[19][21]
OasisPorcine small-intestine submucosaXenogeneic ECM for chronic ulcers[22]

Cellular skin substitutes​

ProductCompositionGU-relevant use
ApligrafBilayered living skin equivalent (fibroblasts + keratinocytes)FDA-approved for diabetic foot ulcers and venous leg ulcers; reduces time to closure[22]
Cultured epithelial autografts (CEA)Autologous keratinocytesMassive burns > 90% TBSA rescue[19]
ReCell (Avita)Autologous cell harvesting device → suspension of keratinocytes, fibroblasts, melanocytes from small biopsySpray application; expanding role in burn and complex reconstruction[19]

Evidence — biologic skin substitutes​

Gordon 2019 meta (25 studies): wounds treated with biologic skin substitutes were 1.67× more likely to heal by 12 weeks than standard-of-care dressings (p < 0.05).[23]

Placenta-derived products​

Cryopreserved or dehydrated amniotic membrane. Armstrong 2023 meta (11 RCTs, diabetic foot ulcers): 66.9% vs 34.1% complete healing at 12–16 weeks (RR 2.0).[24]

Platelet-Rich Plasma & Recombinant Growth Factors​

PRP is an autologous concentrate rich in platelets and growth factors (PDGF, TGF-β, VEGF, EGF, IGF) obtained by centrifuging the patient's blood.[25][26]

Evidence​

  • RCTs and meta-analyses show PRP increases complete wound closure in chronic ulcers with odds ratios ~ 2–8 vs standard care, without increased AEs[25]
  • Recombinant PDGF-BB (becaplermin / Regranex) is the only FDA-approved growth factor for diabetic foot ulcers[27][25]
  • Topical EGF and bFGF shorten healing time by ~ 3 days in superficial partial-thickness burns and > 5 days in deeper burns[25]

Limitations​

  • No standardized preparation protocol — platelet concentrations vary widely across preparations[28]
  • Autologous by definition — not available off-the-shelf

GU-specific PRP uses​

PRP has a broader evidence base in urologic-specific uses (Peyronie's disease, erectile dysfunction, urethroplasty adjunct, vulvodynia). See the pharmacology hub: Platelet-rich plasma.

Hyperbaric Oxygen Therapy (HBOT)​

HBOT delivers 100% oxygen at supraatmospheric pressures.[12][27]

  • Proposed to augment healing in diabetic foot ulcers and radiation-related wounds — relevant for cystitis-radiation fistulas, post-pelvic-radiation perineal wounds, osteoradionecrosis of the pubis
  • Evidence remains mixed and HBOT is typically reserved as an adjunct for refractory wounds rather than first-line therapy
  • Practical barrier: limited availability outside dedicated centers; scheduling and insurance-coverage hurdles

Quick-Reference Decision Matrix​

ScenarioFirst-line adjunct
Small superficial low-tension GU lacerationDermabond; Prineo for longer incisions[1][5]
STSG donor site (phalloplasty, perineal recon)Hydrocolloid (DuoDERM) — fastest healing; avoid gauze[10]
Fournier's post-debridementNPWT + planned staged closure / graft[13]
High-risk primarily closed pelvic incisionClosed-incision NPWT (ciNPWT / Prevena)[12][14]
Chronic diabetic foot / perineal ulcerNPWT, then biologic skin substitute or amniotic membrane if stalled[16][23][24]
Deep wound with exposed bone / tendon / fasciaADM (Integra or AlloDerm) followed by thin autograft[19][20]
Chronic ulcer refractory to standard careConsider PRP, recombinant PDGF (becaplermin), or amniotic membrane[24][25]
Radiation-related non-healing woundConsider HBOT as an adjunct[12][27]

Practical Pearls​

  • Cyanoacrylate is not a tension-sharing closure. Cochrane shows sutures prevent dehiscence better (RR 3.35; NNH 43) — reserve Dermabond for small superficial low-tension approximation. Prineo is a legitimate mesh-augmented option for longer incisions.[3][5]
  • Steri-Strips add nothing over a good subcuticular closure (Custis 2015). Use them when they save time, not when they are supposed to improve outcomes.[6]
  • Hydrocolloid is the default STSG donor-site dressing. 7 days faster healing than all comparators; gauze doubles the infection rate.[10]
  • NPWT is the workhorse of complex GU wound care. The 87% vs 29% closure-rate advantage over moist therapy in diabetic foot ulcers generalizes to many Fournier's and post-debridement perineal wounds.[16]
  • Closed-incision NPWT (Prevena) is the high-yield peri-operative use — consider in obese, diabetic, previously irradiated, or redo patients at high SSI risk.[12][14]
  • Integra is a two-stage operation — template first, then thin autograft once the neodermis has formed. Plan accordingly and counsel the patient about the interval.[20]
  • PRP has broad wound-healing literature but no standardized prep. Platelet concentration varies ~ 3-fold across machines. For GU-specific PRP uses see the pharmacology PRP hub.[25][28]
  • Becaplermin (Regranex) is the only FDA-approved growth factor for wound healing — diabetic foot ulcer indication only.[25][27]
  • HBOT is last-line for refractory radiation or diabetic wounds — evidence is mixed and access is limited.[12][27]

References​

1. Bruns TB, Worthington JM. "Using tissue adhesive for wound repair: a practical guide to Dermabond." Am Fam Physician. 2000;61(5):1383–1388.

2. Jenkins LE, Davis LS. "Comprehensive review of tissue adhesives." Dermatol Surg. 2018;44(11):1367–1372. doi:10.1097/DSS.0000000000001576

3. Dumville JC, Coulthard P, Worthington HV, et al. "Tissue adhesives for closure of surgical incisions." Cochrane Database Syst Rev. 2014;(11):CD004287. doi:10.1002/14651858.CD004287.pub4

4. De Simone B, Sartelli M, Coccolini F, et al. "Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines." World J Emerg Surg. 2020;15(1):10. doi:10.1186/s13017-020-0288-4

5. Kulkarni S, Goodbun M, Chowdhury M, Stather PW. "Dermabond Prineo: a systematic review and meta-analysis." J Wound Care. 2025;34(3):220–226. doi:10.12968/jowc.2023.0024

6. Custis T, Armstrong AW, King TH, Sharon VR, Eisen DB. "Effect of adhesive strips and dermal sutures vs dermal sutures only on wound closure: a randomized clinical trial." JAMA Dermatol. 2015;151(8):862–867. doi:10.1001/jamadermatol.2015.0174

7. Kerrigan CL, Homa K. "Evaluation of a new wound closure device for linear surgical incisions: 3M Steri-Strip S surgical skin closure versus subcuticular closure." Plast Reconstr Surg. 2010;125(1):186–194. doi:10.1097/PRS.0b013e3181c2a492

8. Forsch RT, Little SH, Williams C. "Laceration repair: a practical approach." Am Fam Physician. 2017;95(10):628–636.

9. Younis AS, Abdelmonem IM, Gadullah M, et al. "Hydrogel dressings for donor sites of split-thickness skin grafts." Cochrane Database Syst Rev. 2023;8:CD013570. doi:10.1002/14651858.CD013570.pub2

10. Brölmann FE, Eskes AM, Goslings JC, et al. "Randomized clinical trial of donor-site wound dressings after split-skin grafting." Br J Surg. 2013;100(5):619–627. doi:10.1002/bjs.9045

11. Moellhoff N, Lettner M, Frank K, Giunta RE, Ehrl D. "Polylactic acid membrane improves outcome of split-thickness skin graft donor sites: a prospective, comparative, randomized study." Plast Reconstr Surg. 2022;150(5):1104–1113. doi:10.1097/PRS.0000000000009629

12. Singh D, Chopra K, Sabino J, Brown E. "Practical things you should know about wound healing and vacuum-assisted closure management." Plast Reconstr Surg. 2020;145(4):839e–854e. doi:10.1097/PRS.0000000000006652

13. Iheozor-Ejiofor Z, Newton K, Dumville JC, et al. "Negative pressure wound therapy for open traumatic wounds." Cochrane Database Syst Rev. 2018;7:CD012522. doi:10.1002/14651858.CD012522.pub2

14. Norman G, Shi C, Goh EL, et al. "Negative pressure wound therapy for surgical wounds healing by primary closure." Cochrane Database Syst Rev. 2022;4:CD009261. doi:10.1002/14651858.CD009261.pub7

15. Zens Y, Barth M, Bucher HC, et al. "Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials." Syst Rev. 2020;9(1):238. doi:10.1186/s13643-020-01476-6

16. Gu H, Zhao X, Sun Y, Ding Y, Ouyang R. "Negative-pressure wound therapy compared with advanced moist wound therapy: a comparative study on healing efficacy in diabetic foot ulcers." Surgery. 2025;180:109098. doi:10.1016/j.surg.2024.109098

17. Haxho F, Lytvyn Y, Shelley AJ, et al. "Wound care — part II: tissue-engineered skin substitutes & other advanced wound therapies." J Am Acad Dermatol. 2025. doi:10.1016/j.jaad.2025.06.045

18. Davis M, Dugan K, Neill B, Shive M, Tolkachjov S. "The role of skin substitutes in dermatologic surgery: a practical review." J Drugs Dermatol. 2023;22(5):475–480. doi:10.36849/JDD.7132

19. Jeschke MG, Herndon DN. "Burns in children: standard and new treatments." Lancet. 2014;383(9923):1168–1178. doi:10.1016/S0140-6736(13)61093-4

20. Magnoni C, De Santis G, Fraccalvieri M, et al. "Integra in scalp reconstruction after tumor excision: recommendations from a multidisciplinary advisory board." J Craniofac Surg. 2019;30(8):2416–2420. doi:10.1097/SCS.0000000000005717

21. Patel S, Ziai K, Lighthall JG, Walen SG. "Biologics and acellular dermal matrices in head and neck reconstruction: a comprehensive review." Am J Otolaryngol. 2022;43(1):103233. doi:10.1016/j.amjoto.2021.103233

22. Frykberg RG, Zgonis T, Armstrong DG, et al. "Diabetic foot disorders. A clinical practice guideline (2006 revision)." J Foot Ankle Surg. 2006;45(5 Suppl):S1–S66. doi:10.1016/S1067-2516(07)60001-5

23. Gordon AJ, Alfonso AR, Nicholson J, Chiu ES. "Evidence for healing diabetic foot ulcers with biologic skin substitutes: a systematic review and meta-analysis." Ann Plast Surg. 2019;83(4S Suppl 1):S31–S44. doi:10.1097/SAP.0000000000002096

24. Armstrong DG, Tan TW, Boulton AJM, Bus SA. "Diabetic foot ulcers: a review." JAMA. 2023;330(1):62–75. doi:10.1001/jama.2023.10578

25. Ahmed AB, Thatcher S, Khorsandi J, et al. "Platelet-rich plasma (PRP) and recombinant growth factor therapies in cutaneous wound healing: mechanisms, clinical applications, and future directions." J Clin Med. 2025;14(23):8583. doi:10.3390/jcm14238583

26. Cecerska-Heryć E, Goszka M, Serwin N, et al. "Applications of the regenerative capacity of platelets in modern medicine." Cytokine Growth Factor Rev. 2022;64:84–94. doi:10.1016/j.cytogfr.2021.11.003

27. Singer AJ, Tassiopoulos A, Kirsner RS. "Evaluation and management of lower-extremity ulcers." N Engl J Med. 2017;377(16):1559–1567. doi:10.1056/NEJMra1615243

28. Oneto P, Etulain J. "PRP in wound healing applications." Platelets. 2021;32(2):189–199. doi:10.1080/09537104.2020.1849605