Annotated Bibliography

Bruns TB and Worthington JM. Using tissue adhesive for wound repair: a practical guide to Dermabond®., Am Fam Physician 61, 1383-8, 2000. Summary
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. Summary
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 group.
Davis SC et al. An octyl-2-cyanoacrylate formulation speeds healing of partial-thickness wounds., Dermatolog Surg 27:9, 783-8, Sep, 2001. Summary
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 hemostasis.
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. Summary
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. Summary
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. Summary
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, April, 2000. Summary
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, Feb, 1997. Summary
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 seconds).
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. Summary
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. Summary
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. Summary
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. Summary
This article offers a conservative round-up of octyl-2-cyanoacrylate adhesives benefits in clinical application and spells out their advantages over butylcyanoacrylates.
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. Summary
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 treatment.
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. Summary
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. Summary
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. Summary
This article demonstrates an ophthalmologic use of octyl-2 cyanoacrylates in an application where previous-generation cyanoacrylates had not worked well.
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. Summary
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, Oct, 1997. Summary
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. Summary
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. Summary
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. Summary
This article shows octyl-2 cyanoacrylate is as effective as conventional suturing but is faster and patients prefer it, implying that it is less painful.
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.”