Tissue Adhesive

Aka: Tissue Adhesive, Dermabond, Cyanoacrylate Tissue Adhesive, Skin Glue, Surgiseal, Histoacryl Blue, PeriAcryl

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II. Indications

  1. Laceration Repair of well-approximated, low tension, superficial Lacerations with linear edges

III. Contraindications

  1. Lesions near the eye
  2. Deep wounds
  3. Complex, jagged edged wounds
  4. High tension wounds (e.g. over joints, hands)
  5. Active bleeding
  6. Contaminated wound
  7. Infected wound (leave open)
  8. Bite wound
  9. Wounds >12 hours old

IV. Efficacy

  1. Alternative to suturing
  2. Highly effective in <5cm low tension Laceration Repairs
    1. Bruns (1996) Pediatrics 98:673-5 [PubMed]
  3. Excellent cosmetic results (similar result to Suture)
    1. Simon (1997) Pediatrics 99:193-5 [PubMed]

V. Precautions

  1. Do not cover with Antibiotic ointment or petrolatum (dissolves the tissue glue)
    1. Petrolatum can be used to remove glue from unwanted areas (e.g. Eyelid)
  2. Avoid Tissue Adhesive near the eye
    1. Risk of Cyanoacrylate Eye Injury
    2. Higher risk of secondary Wound Infection with Periorbital Cellulitis (6 fold increased risk)
      1. Yeilding (2012) J AAPOS 16(2):168-72 [PubMed]
  3. Do not substitute ethyl cyanoacrylate (e.g. Crazy Glue)
    1. Ethyl cyanoacrylate polymerization is too fast (Burn Injury risk) and it degrades too quickly

VI. Preparations

  1. n-butyl-2-cyanoacrylate (Histoacryl Blue, PeriAcryl)
  2. 2-octyl cyanoacrylate (Dermabond, Surgiseal)

VII. Techniques: Wound Apposition

  1. See Hair Apposition Technique (Scalp Lacerations)
  2. Steri-strip technique
    1. First: Align and approximate the wound edges with steri strips
    2. Next: Apply the Tissue Adhesive

VIII. Techniques: Skin Protection

  1. Indications
    1. Protect adjacent areas from Tissue Adhesive spread (e.g. eye)
  2. Tilt bed/body
    1. Position patient in trendelenberg, reverse trendelenberg or lateral recumbent position)
    2. Adhesive glue follows gravity to drain away from a sensitive area
  3. Petroleum-based barrier (e.g. petrolatum, Vaseline) technique
    1. Apply at the margins of the wound area to prevent spill-over to adjacent sensitive areas
  4. Tegaderm (Transparent Film Dressing)
    1. Fold Tegaderm in half and cut-out a central opening or fenestration to access the wound
    2. Unfold the Tegaderm and position with the hole over the wound
    3. Apply pressure to the Tegaderm edges to ensure tight skin adherence

IX. Techniques: Drying base

  1. Indications
    1. Peristently draining sites (e.g. Paracentesis site)
  2. Technique
    1. Oxygen by Nasal Cannula with prongs directed to blow onto wound site at 10-15 L/min assists in keeping the site dry
  3. References
    1. Lin in Herbert (2013) EM:Rap 13(11): 9

X. References

  1. Lin in Herbert (2015) EM:Rap 15(2): 6-7

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