Which tissue adhesive for wounds?☆
Introduction
Optimal wound healing requires well-approximated wound edges. To approximate wound edges by suturing, local anaesthetic has to be injected. Children may be distressed by such a procedure, which is also time consuming. Tissue adhesives (TAs) are alternatives to suturing and steristrips for wound approximation. Three types of TAs are available in the United Kingdom. This study is aimed at comparing the three: N-butyl-1,2-cyanoacrylate (Histoacryl blue), 2-octyl-cyanoacrylate (Dermabond) and Enbucrylate (Indermil) regarding technique, wound healing, satisfaction, merits and complications.
Section snippets
Patients and methods
Fifty-one children aged between 1 and 14 years presenting with isolated and uncomplicated cuts of the scalp or face, less than 6 h duration and less than 2.5 cm in length were included in the study, with the consent of carers and children. Seventeen children were treated with each TA. Hair was not trimmed or shaved. After cleaning the wound with saline, the TA was applied to a dry field, using gloved index and thumb of the non-dominant_hand_to approximate the edges of the wound.
Technique
The proportion of difficulties encountered by staff in applying TA by the contact method was greater than those using the non-contact method. Forty-seven percent of cases treated with the contact method had difficulties whereas in the non-contact group only 12% experienced difficulties (Chi-square P=0.013).
Satisfaction
For children treated by the contact method, four carers were dissatisfied whereas in the non-contact group one carer was dissatisfied with the outcome (Fisher’s exact P=0.653). Levels of
Discussion
Cyanoacrylates were first discovered in 1949 and were used as TA by Coover et al. 1 TA has been used in facial plastic surgery 2, scalp wounds 3, otorhinolaryngology 4 and lacerations in children 5 and has been noted to be an alternative to suturing for paediatric lacerations 6. Histoacryl blue (N-butyl-1,2-cyanoacrylate) has been available for several years 5, but Indermil and Dermabond were introduced to the UK market in 1996 and 1998, respectively. Therefore, this study was done comparing
Conclusion
The use of TA was, in general, satisfactory to all concerned—children, carers and staff. The glue effect was similar in all the three TAs. Non contact instillation of TA was superior to contact application. It was advantageous to use gloved fingers to approximate the wound edges. In the unfortunate event that the glove was stuck to the TA, it can be cut and left at the wound site, without disrupting the wound while attempting to release the stuck glove. Use of glove also helped to prevent
Acknowledgements
We thank Ethicon, Braun and Kendall & Company for providing the tissue adhesives for this study. Our sincere thanks are due to Mrs. Claire Donati for the secretarial assistance, Mrs. Cathy Clark for the illustrations and Mr. David Young for statistical analysis.
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2014, Carbohydrate PolymersCitation Excerpt :Many studies have focused on surgical tissue adhesives for joining tissues together; typically, these adhesives are composed of synthetic or biological compounds, or their combinations (Li et al., 2014; Lim, Kim, & Park, 2012). Cyanoacrylates are very common synthetic glues, which rapidly polymerize on contact with water or blood (Doraiswamy, Baig, Hammett, & Hutton, 2003). Cyanoacrylates have high adhesive strength; however, they cause systemic inflammatory responses (Ramond, Valla, Gotlib, Rueff, & Benha-Moou, 1986) and have poor handling properties (Bhasin, Sharma, Prasad, & Singh, 2000); high cytotoxicities have also been reported (Bhatia, Arthur, Chenault, & Kodokian, 2007).
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2010, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :Presently, tissue adhesives and sealants have a limited use in oral and maxillofacial surgical procedures.17 Skin closure occurs regularly with cyanoacrylate adhesives.18–23 Sealing of dural tears in conjunction with dural closure has been shown to be very successful.
Interaction force measurements for the design of tissue adhesives
2009, Acta BiomaterialiaA prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds
2006, International Journal of Oral and Maxillofacial SurgeryTailoring lactide/caprolactone co-oligomers as tissue adhesives
2004, Biomaterials
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Presented in the XLVI Annual International Congress of British Association of Paediatric Surgeons, Liverpool, UK, 20–23 July 1999.