II. Indications
- Laceration Repair of well-approximated, low tension, superficial Lacerations with linear edges
III. Contraindications
- Lesions near the eye
- Deep wounds
- Complex, jagged edged wounds
- High tension wounds (e.g. over joints, hands)
- Active bleeding
- Contaminated wound
- Infected wound (leave open)
- Bite wound
- Wounds >12 hours old
IV. Efficacy
- Alternative to suturing
- Highly effective in <5cm low tension Laceration Repairs
- Excellent cosmetic results (similar result to Suture)
V. Precautions
- Do not cover with Antibiotic ointment or petrolatum (dissolves the tissue glue)
- Petrolatum can be used to remove glue from unwanted areas (e.g. Eyelid)
- Avoid Tissue Adhesive near the eye
- Risk of Cyanoacrylate Eye Injury
- Higher risk of secondary Wound Infection with Periorbital Cellulitis (6 fold increased risk)
- Do not substitute ethyl cyanoacrylate (e.g. Crazy Glue)
- Ethyl cyanoacrylate polymerization is too fast (Burn Injury risk) and it degrades too quickly
VI. Preparations
- n-butyl-2-cyanoacrylate (Histoacryl Blue, PeriAcryl)
- 2-octyl cyanoacrylate (Dermabond, Surgiseal)
VII. Techniques: Wound Apposition
- See Hair Apposition Technique (Scalp Lacerations)
- Steri-strip technique
- First: Align and approximate the wound edges with steri strips
- Next: Apply the Tissue Adhesive
VIII. Techniques: Skin Protection
- Indications
- Protect adjacent areas from Tissue Adhesive spread (e.g. eye)
- Tilt bed/body
- Position patient in trendelenberg, reverse trendelenberg or lateral recumbent position)
- Adhesive glue follows gravity to drain away from a sensitive area
- Petroleum-based barrier (e.g. petrolatum, Vaseline) technique
- Apply at the margins of the wound area to prevent spill-over to adjacent sensitive areas
- Tegaderm (Transparent Film Dressing)
IX. Techniques: Drying base
- Indications
- Peristently draining sites (e.g. Paracentesis site)
- Technique
- Oxygen by Nasal Cannula with prongs directed to blow onto wound site at 10-15 L/min assists in keeping the site dry
- References
- Lin in Herbert (2013) EM:Rap 13(11): 9
X. References
- Lin in Herbert (2015) EM:Rap 15(2): 6-7