Chapter 117: Tissue Adhesives for Wound Repair

INTRODUCTION

The year 1942 marked the discovery of cyanoacrylate, the chemical found in adhesives such as Superglue.¹ The use of cyanoacrylates for wound closure has been described since the 1960s when it was first assessed for military use. It was not until 1998 that N-2-octylcyanoacrylate (i.e., Dermabond) was approved by the Food and Drug Administration (FDA) for use in the United States. Tissue adhesives have since redefined the overall approach to laceration repair, especially in the Emergency Department. Their ease of use, relative painlessness, and simplicity of aftercare make it an ideal tool for small straight wounds and use in children.^2,3 There has been an increase in companies producing topical tissue adhesives for wound closure (Table 117-1).

ANATOMY AND PATHOPHYSIOLOGY

Cyanoacrylates are a monomer liquid. They polymerize when activated by water via an exothermic reaction to form a strong bond. Heat is released by this polymerization reaction and may cause some discomfort. Cyanoacrylates are classified as either butyl or octyl based on the side chain (Table 117-2).^4,5 Butyl cyanoacrylates have short and straight side chains. This allows them to form bonds that are poorly flexible, strong, and tight. Unfortunately, these bonds can become brittle and fracture. Butyl cyanoacrylates are best suited for short lacerations under no tension. Examples of butyl cyanoacrylates include Histoacryl (B. Braun, Bethlehem, PA) (Figure 117-1) and Indermil (Syneture, Norwalk, CT) (Figure 117-2). Octyl cyanoacrylates have longer side chains. This allows them to form bonds that are flexible, less likely to fracture, and strong. Octyl cyanoacrylates can be used on lacerations of any length. Examples of octyl cyanoacrylates include Dermabond (Ethicon Corp., Norwood, MA) (Figure 117-3), Exofin (Chemence Medical Inc., Alpharetta, GA) (Figure 117-4), and SurgiSeal (Pfizer Inc., New York, NY) (Figure 117-5). Newer agents are a combination of the strong and fast-setting butyl cyanoacrylates with the flexibility of the octyl cyanoacrylates. An example is LiquiBand (Advanced Medical Solutions Inc., Plymouth, United Kingdom) (Figure 117-6).