Comparative efficacy of various wound dressings on scar formation following thyroidectomy: a systematic review and meta-analysis.

Abstract

Background: Visible cervical scarring remains a common concern following conventional thyroidectomy and may adversely affect cosmetic satisfaction and quality of life. Although several postoperative wound interventions have been introduced to improve scar healing, their comparative effectiveness remains uncertain because of inconsistent findings across randomized controlled trials (RCTs). Aim: To systematically evaluate the effectiveness of postoperative wound interventions in improving scar outcomes following thyroidectomy and thyroid/parathyroid surgery. Materials & methods: PRISMA 2020-guided systematic review and meta-analysis searched PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials from inception to January 2026 for RCTs of postoperative wound interventions in adults undergoing thyroidectomy or thyroid/parathyroid surgery. Interventions included adhesive/tissue glue techniques, wound-protector devices, and oxygen therapy dressings versus postoperative wound management. Scar outcomes used instruments including the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. Random-effects meta-analysis reported standardized mean differences (SMDs) with 95% CIs. Results: Fourteen RCTs met the inclusion criteria for qualitative synthesis, of which seven independent effect sizes were eligible for quantitative meta-analysis. Overall, postoperative wound interventions did not significantly improve scar outcomes compared with conventional wound management when pooled across all intervention types (SMD: -0.21; 95% CI: -0.45 to 0.04; p = 0.10), reflecting substantial heterogeneity between intervention categories (I² = 74%). Considered separately, wound-protector devices demonstrated a significant improvement in scar outcomes (SMD: -0.84; 95% CI: -1.06 to -0.62; p < 0.001), whereas tissue adhesives produced cosmetic results comparable to conventional subcuticular sutures, with no measurable scar-quality advantage (SMD: 0.14; 95% CI: -0.12 to 0.40; p = 0.29). Continuous diffusion oxygen therapy showed promising early clinical benefits but was evaluated in only one randomized trial and was therefore summarized narratively. Conclusion: Current randomized evidence indicates that the benefit of postoperative wound interventions on scar outcomes is intervention-specific rather than a uniform class effect: wound-protector devices show a consistent, statistically significant benefit, whereas the pooled effect across all intervention types combined does not reach significance. Tissue adhesives provide satisfactory outcomes and efficient wound closure without a measurable scar-quality advantage over standard sutures, and evidence for oxygen therapy remains preliminary. Larger, well-designed trials using standardized scar assessment and longer follow-up are required to establish optimal postoperative scar management.