|Bruns TB and Worthington JM. Using
tissue adhesive for wound repair: a practical guide to Dermabond®.,
Am Fam Physician 61, 1383-8, 2000.
This proof source is a solid basic primer on the use of Dermabond®
liquid adhesive and highlights some key benefits, including the preference
children show for “glue” over conventional sutures. Dermabond®
is as safe and effective as conventional sutures but is less painful,
quicker to apply, and offers a waterproof closure for the wound.
|This comprehensive and illustrated article is a basic
primer on the use of Dermabond® adhesive, particularly for pediatric
patients. It reports that the product is as safe and effective as
conventional sutures while offering several benefits, including providing
a water-resistant covering to the wound, reducing pain, and saving
clinical time. The authors caution that the product is best used on
small superficial lacerations but advises physicians that it can be
used “with confidence” on larger wounds that require subcutaneous
sutures. The article offers a history of the Dermabond® product
and concludes with a thorough how-to section.
|Bruns TB et al. A new tissue
adhesive for laceration repair in children, J Pediatr 132:6,
1067-70, Jun, 1998.
This study shows that tissue adhesive is a safe and effective method
of closing certain types of lacerations in children that saves clinical
time and causes children less pain.
|Eighty-three children presenting at
an emergency department with lacerations were randomized into an adhesive
(octylcyanoacrylate) or nonabsorbable sutures group. The authors assessed
length of time required to make the repair, parental assessment of
the pain their children experienced during the repair, and cosmetic
evaluation. The adhesive was significantly faster (2.9 min. v. 5.8
min.) and parents reported their children felt less pain with adhesives
than sutures. The tissue adhesive group had slightly lower cosmetic
scores which the authors found “comparable” to the suture
|Davis SC et al. An octyl-2-cyanoacrylate
formulation speeds healing of partial-thickness wounds., Dermatolog
Surg 27:9, 783-8, Sep, 2001.
While all occlusive dressings are known to accelerate the rate of
healing, this article demonstrates that octylcyanoacrylates offer
improved benefits in addition to providing immediate and complete
|This study compared octyl-2-cyanoacrylate
adhesive to over-the-counter bandages on partial-thickness wounds
in eight pigs with evaluation points of epitheliazation, erythema,
scab formation, material adherence, hemostasis, and infection. The
tissue adhesive provided immediate and complete hemostasis and was
the only wound dressing tested to do so. In addition, the adhesive
improved the rate of ephitheliazation, reduced scab formation, and
did not irritate the skin (erythema). The authors conclude that octyl-2-cyanoacrylate
adhesive dressings stop bleeding immediately while enhancing healing
of partial thickness wounds.
|Ferlise VJ, Ankem MK, Barone JG,
Use of cyanoacrylate tissue adhesive under a diaper. BJU
Int 87: 7, 672-3, May, 2001.
Even for wounds constantly exposed to bodily fluids, cyanoacrylate
closure was as safe and effective as conventional suturing.
|This retrospective study evaluated 45
boys (two years and under, none toilet trained) who underwent either
inguinal hernia, hydrocele repair, or orchidopexy. A total of 52 incisions
in 45 children were studied; 27 of the incisions were sutured, while
25 were closed with cyanoacrylate (Dermabond® adhesive). All patients
were followed up at two weeks with no cases of infection or wound
deniscence in either group. Cosmetic results were equivalent in both
groups at three months. The authors conclude that cyanoacrylates are
safe and effective for wound closure, even under diapers.
|Herod EL, Cyanoacrylates in
dentistry: a review of the literature. J Can Dent Assoc 56:4,
331-4, April, 1990.
Today’s more advanced formulations bear witness to the author’s
prediction of the usefulness of cyanoacrylate adhesives in dentistry.
|This older article indicates the early
promise of cyanoacrylate-based technology, which recent products have
even exceeded The author explains the nature of cyanoacrylates and
how they are bacteriostatic for many bacteria types, hemostatic, and
tissue compatible. Foreign body response was shown to increase when
cyanoacrylates were placed deeper into the body compared to topical
application. Newer (post-1990) cyanoacrylate materials are held by
the author to be of interest for broader dental use.
|Kim YM, Gupta BK, 2-octyl
cyanoacrylate adhesive for conjunctival wound closure in rabbits.,
J Pediatr Ophthalmol Stabismus 40: 3, 152-5, May-June, 2003.
This article demonstrates good results in a very small study of rabbits
for using octyl-2-cyanoacrylates for conjunctival wounds.
|The efficacy and histology of 2-octyl
cyanoacrylates on conjunctival wound closure in ten rabbits is evaluated.
Eight of the ten rabbits tested had conjunctival wounds repaired with
2-octyl cyanoacrylate; the other two rabbits were controls. Four rabbits
were killed (two at one week and two at two weeks post-op) and their
conjunctivae examined histologically. Conjunctival strips were obtained
from the remaining rabbits for tensile strength testing. Histology
exams showed minimal inflammation; all wounds closed well; and tensile
strength of conjunctival strips was measured at 25.5 g. The authors
reach the conclusion that 2-octyl-cyanoacrylates may be a possible
tissue adhesive for closure of conjunctival wounds.
|Marcovich R et al. Comparison
of 2-octyl cyanoacrylate adhesive, fibrin glue, and suturing for wound
closure in the porcine urinary tract., Urology 57: 4, 806-10,
Seeking a safe, effective and reliable adhesive to facilitate laparoscopic
surgery, the authors compared fibrin glue to octyl-2 cyanoacrylates
with dramatically better results from the latter.
|To compare octyl-2 cyanoacrylate glue
to fibrin glue for a large bladder wound, the authors performed a
7.5-cm cystotomy on 16 female pigs, of which half were closed with
octyl-2 cyanoacrylate and half with fibrin glue. (In each group, six
pigs underwent open and two laparoscopic procedures.) The animals
were tested at two days and four weeks for leakage (by filling bladders
with saline to 200 mm Hg pressure) and their cystotomy scars were
inspected. None of the octyl-2 cyanoacrylate group showed any leakage
at four weeks, while half of the fibrin glue group died before four
weeks because of massive urine leak. Histology was similar for both
groups. According to the authors, these results indicate that octyl-2
cyanoacrylate adhesives are strong enough to hold a large bladder
wound, while fibrin glue was consistently inadequate.
|Maw JL et al. A prospective
comparison of octylcyanoacrylate tissue adhesive and suture for the
closure of head and neck incisions, J Otolaryngol 26:1, 26-30,
This proof source confirms what other authors found, namely that tissue
adhesive yields comparable cosmetic results to convention sutures
but are faster and less painful to patients. The significance of this
study is that it concentrates specifically on head and neck incisions,
which other notable articles excluded.
|The authors devised a prospective blinded
comparison of tissue adhesive octylcyanoacrylate with subcuticular
suture for the closure of head and neck incisions using cosmetic appearance
as obtained by photograph at four to six weeks as primary outcome.
A total of 50 patients were enrolled (26 suture) and photographs were
evaluated using a visual analog scale by two facial-plastic otolaryngologists.
There were no complications and similar visual analog scores in both
groups. The adhesive was significantly faster (29.7 seconds vs. 289.0
|Mertz PM et
al. Barrier and antibacterial properties of 2-octyl cyanoacrylate-derived
wound treatment films., J Cutan Med Surg 7: 1, 1-6, Jan-Feb, 2003.
Cyanoacrylate closure acts as a safe and effective barrier to bacterial
infection. Furthermore, cyanoacrylate closures were shown to have
an effective and significant antimicrobial action.
|The authors evaluated barrier and antimicrobial
properties in partial thickness wounds in pigs by comparing a cyanoacrylate-based
bandage, a conventional wound dressing, and air-exposed wounds. Bacteria
(staphylococcus aureus or Pseudomonas aeruginosa) were inoculated
over the test materials that were placed on the wounds and bacteria
were counted at 24, 48 and 72 hours post inoculation. The cyanoacrylate
closure showed itself to be a reliable barrier with no bacteria recovered.
In a related study, wounds in pigs were inoculated with bacteria and
covered with a cyanoacrylate closure, standard bandage, hydrocolloid
bandage or left open to the air. Bacteria were recovered and from
the wound at 24 and 72 hours and quantitated. In the antimicrobial
study, it was demonstrated that the cyanoacrylate closure reduced
the number of inoculated bacteria compared to all of the other groups.
|Narang U, Cyanoacrylate medical
adhesives—a new era Colgate ORABASE Soothe.N.Seal Liquid Protectant
for canker sore relief., Compend Contin Educ Dent Suppl 32, 7-11;
quiz 22, 2001.
An excellent introduction to Soothe.N.Seal and the use of 2-octyl
cyanoacrylates for oral care, this article also offers the history
of how cyanoacrylates were developed as well as a general overview
of how they work compared to similar medical adhesives.
|This article reports on the only over-the-counter
cyanoacrylate-based adhesive commercially available at the time and
how it works. The product is Soothe.N.Seal which is a liquid monomer
substance that polymerizes instantly into a flexible polymer barrier
film that adheres to mucosal tissue. This particular product offers
pain relief from mouth ulcers, irritations, and canker sores and promotes
natural healing. The article also discusses the chemical properties
of 2-octyl cyanoacrylates, their history, and further application.
|Narang U. et al. In-vitro
analysis for microbial barrier properties of 2-octyl cyanoacrylate-derived
wound treatment films. J Cutan Med Surg 7:13-19, 2003.
This study offers powerful evidence that 2-octyl cyanoacrylate adhesives
acts as microbial barriers.
|In order to evaluate how well 2-octyl-cyanoacrylate
acts as a microbial barrier, the authors designed an in-vitro
test of nine microorganisms using both prepolymerized adhesive films
and adhesive films polymerized in situ. The plates were arranged
in such a way that the organisms would have to penetrate the film
in order to colonize the media beneath. Plates were examined at two,
four, and seven days post-inoculation. With one exception, there was
no growth in any of the tests. The exception involved a prepolymerized
film inoculated with Pseudomonas aeruginosa, but the growth pattern
suggests that the organism traveled around rather than through the
film. The authors conclude that 2-octyl cyanoacrylate films do indeed
act as microbial barriers.
|Penoff J, Skin closures using
cyanoacrylate tissue adhesives. Plastic Surgery Educational Foundation
DATA Committee. Device and Technique Assessment., Plast Reconstr
Surg 103:2, 730-1, Feb, 1999.
This article offers a conservative round-up of octyl-2-cyanoacrylate
adhesives benefits in clinical application and spells out their advantages
|This article appeared on the eve of
FDA approval of Dermabond® adhesive and sums up the benefits of
octyl-2 cyanoacrylates for wound closure. The article reports that
the adhesive is thin, durable, flexible, and waterproof. It reports
that this adhesive is superior to the butylcyanoacrylates currently
used in Canada and elsewhere (but not approved in the USA). This early
article makes some tentative recommendations for the use of this adhesive,
including for pediatric patients, for patients who cannot easily return
to the clinic for follow-up, and for lacerations under casts. It does
not recommend this adhesive for high-mobility areas.
|Perron, AD et al. The efficacy
of cyanoacrylate-derived surgical adhesive for use in the repair of
lacerations during competitive athletics., Am J Emerg Med 18:
3, 261-3, May, 2000.
This article shows that Dermabond® is a tough, flexible, and durable
wound closure mechanism that withstands activity.
|The authors tested Dermabond® adhesive
on 32 lacerations in 28 professional hockey players at two games.
The wounds (95% were facial) were anesthetized, irrigated, debrided,
and closed with Dermabond® adhesive. Players returned immediately
to the game. At the end of play, wounds were studied and again seven
days later. Of the wounds, 98% had good results at the end of the
game and all of these showed good results seven days later. The authors
conclude that Dermabond retained its strength and durability, even
when a person returned to vigorous activity immediately following
|Quinn, J et al. A randomized
trial comparing octylcyanoacrylate tissue adhesive and sutures in
the management of lacerations. JAMA 277:19, 1527, May 21, 1997.
This article shows that while octyl-2 cyanoacrylates are equivalent
to conventional suturing in terms of safety and efficacy, they add
two significant new benefits: they save valuable clinical time and
cause less pain.
|One hundred thirty adult patients with
lacerations on face, extremities, and torso (but excluding lacerations
on hands, feet, and joints) were randomized into two groups: lacerations
were closed using octylcyanoacrylate tissue adhesive or monofilament
suture. Patients were followed for five months, with a three-month
photo evaluated on a previously validated 100-mm visual analog cosmesis
scale by a surgeon who did not know which method was used. There was
no difference in mean visual analog cosmesis scores or percentage
of early or late optimal wound evaluation scores. However, the octylcyanoacrylate
closed the wounds faster and was less painful (visual analog pain
scores, p<.001). Authors report that octylcyanoacrylate tissue
adhesive is an effective method of wound closure for selected lacerations
which is faster and less painful than using monofilament sutures.
|Quinn J, et al. Octylcyanoacrylate
tissue adhesive versus suture wound repair in a contaminated wound
model., Surgery 122:1, 69-72, Jul, 1997.
This article presents experimental evidence from a randomized animal
study that wounds closed with a cyanoacrylate adhesive show less infection
than sutured wounds.
|This randomized, blinded experimental
study compared whether contaminated wounds closed with octylcyanoacrylate
tissue adhesive will have a lower infection rate compared with wounds
closed with conventional sutures. Using albino guinea pigs, wounds
were contaminated with Staphylococcus aureus and randomized into an
adhesive or suture group. After five days, wounds sections were analyzed
by a histopathologist to see if inflammatory cells with intracellular
cocci could be seen. The wound was then examined for clinical evidence
of infection and bacteriologic analysis. All sutured wounds had positive
cultures, while five wounds in the adhesive group were sterile on
the fifth day. Using histological and clinical criteria, fewer wounds
in the adhesive group were infected. The authors conclude that wounds
closed with adhesives had a lower infection rate than sutured wounds.
|Ricci B, Ricci F, Bianchi PE,
Octyl-2-cyanoacrylate in sutureless surgery of extraocular muscles:
an experimental study in the rabbit model., Graefes Arch Clin
Ophthalmol 238:5, 454-8, May, 2000.
This article demonstrates an ophthalmologic use of octyl-2 cyanoacrylates
in an application where previous-generation cyanoacrylates had not
|Patients with very thin sclerae risk
perforation of the ocular bulb if sutures are used in surgery. In
the quest for sutureless surgery, ophthalmologists used earlier versions
of cyanoacrylates with less than satisfactory results. This article
reports on testing octyl-2 cyanoacrylates versus surtures (5/0 Vicryl)
in 36 rabbit eyes with eyes harvests at one, three, five, 15, 30 and
45 days post-op. A histopathological exam was performed on one eye
and a tensiometric test on the other. While tensile strength was better
in the suture group at one day, it was much closer to equivalent at
45 days. No slippage or muscle detachment was reported. The authors
conclude that octyl-2 cyanoacrylates are superior to previous cyanoacrylates
in this application and also offer a better toxicity profile.
|Ricci B, Ricci F, Octyl 2-cyanoacrylate
tissue adhesive in experimental scleral buckling., Acta Ophthalmol
Scand 79:5, 506-8, Oct, 2001.
This rabbit study showed sutureless sclera buckling (for patients
with certain types of retinal detachment) could be performed safely
and effectively with octyl-2 cyanoacrylates, which prevented slippage
and reduced risk of perforation of the ocular bulb.
|Sutureless surgery holds great promise
for certain types of retinal detachment. This article studies a sutureless
scleral buckling using octyl-2 cyanoacrylate adhesive to fixate a
silicone band to the sclera. Since perforation of the ocular bulb
is a major risk for such procedures, the use of glue to affix the
band to the sclera appears to be a promising alternative. An encircling
band of silicone was sutured in 36 rabbit eyes to three small silastic
patches which were glued to the sclera at the level of the equator.
Anchoring sutures were made, but they passed through silicone. The
band could then be tightened to produce buckling of the sclera. The
ends of the band were glued together with the same adhesive. Eyes
were examined at 15 days to six months after surgery and the buckle
was stable in 33 of the 36 eyes. In the other three eyes, one of the
support patches had become detached, but there was still no evidence
that the buckle had slipped. The authors conclude that use of octyl-2
cyanoacrylates produced a stable buckle up to six months after surgery
and considered this type of adhesive useful for sutureless surgery
for certain types of retinal detachment.
|Singer, AJ et al. Evaluation
and management of traumatic lacerations. NEJM 337:1142-1148,
While not specifically a comparative study, this article provides
a good background for the clinical benefits of adhesives versus suturing
and offers an excellent methodology for treating such wounds.
|This overview article explores methods
of handling traumatic wounds, which account for about 90 million skin-suturing
procedures a year in this country. Traumatic lacerations typically
occur on face, scalp and hands and are more often caused by blunt
injury than animal bites. The authors discuss wound preparation, debridement,
and wound closure techniques, including the use of tissue adhesives
as a potential and promising alternative to conventional suturing.
|Steiner Z, Mogilner J, [Histoacryl
vs Dermabond cyanoacrylate glue for closing small operative wounds].,
Harefuah 139: 11-12, 409-11, 496, Dec, 2000.
These authors recommend topical adhesives for wound closure in pediatric
patients and found Dermabond® adhesive safe and effective with
slightly higher relative ranking compared to Histoacryl.
|Histoacryl and Dermabond® adhesive
were compared in post-ambulatory-surgery wound closures in 157 children,
ranging in age from twelve weeks to three years. Operations were for
inguinal hernia (110 cases), hydrocele (25), undescended testis (16),
umbilical hernia (13) and funiculocele (3). Wounds were checked a
week post-op for closure, infection, and wound granuloma; the wound
was re-examined at three months. In terms of infection and cosmetic
results, there was no difference between products. Parental satisfaction
was slightly higher with Dermabond® adhesive, but the result was
not statistically significant.
|Taravella MJ, Chang CD, 2-Octyl
cyanoacrylate medical adhesive in treatment of a corneal perforation.,
Cornea 20: 2, 220-1, Mar, 2001.
The authors call their results in this particular cornea case “excellent”
and recommend further study of 2-octyl cyanoacrylates for similar
applications. The article reports several benefits, including ease
of use without vascularization, scarring, or thinning.
|This case study reports the use of 2-octyl
cyanoacrylate on a human cornea with an inferior perforation. The
cyanoacrylate adhesive was applied at the slit lamp with a topical
anesthetic. Upon application, the patient reported immediate improved
visual acuity. The authors report that the glue sloughed off after
about six weeks with no scarring, vascularization or thinning.
|Toriumi, DM et al. Use of
octyl-2 cyanoacrylate for skin closure in facial plastic surgery.
Plas Recon Surg 102:6, 2209-19, Nov, 1998.
This article shows octyl-2 cyanoacrylate is as effective as conventional
suturing but is faster and patients prefer it, implying that it is
|One hundred eleven patients undergoing
elective surgery with the same surgeon (most for excision of benign
skin lesions) were randomized into a test group (closure with octyl-2
cyanoacrylate) or control (vertical mattress suture closure). The
mean wound size was 112 cubic mm and surgical judgment was used to
determine which wounds required subcutaneous sutures. Wound closure
was about four times faster with octyl-2 cyanoacrylate. No wound dehiscence,
hematoma or infection occurred in either group, but the octyl-2 cyanoacrylate
showed statistically significant improvement (p=0.03) on a visual
analog scale rating performed at one year by two facial plastic surgeons.
In addition, patient satisfaction in the octyl-2-cyanoacrylate group
was “very high.”