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 (Dermabond) was approved by the 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
Cyanoacrylates are a monomer liquid. When activated by water, they polymerize 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 length of their side chain.20,23 Butyl cyanoacrylates have short and straight side chains. This allows them to form bonds that are strong, tight, and poorly flexible. 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) and Indermil (Syneture, Norwalk, CT). Octyl cyanoacrylates have longer side chains. This allows them to form bonds that are strong, flexible, and less likely to fracture. Octyl cyanoacrylates can be used on lacerations of any length. Examples of octyl cyanoacrylates include Dermabond (Ethicon Corp., Norwood, MA) and SurgiSeal (Adhezion Biomedical, Wyomissing, PA). Newer agents are a combination of the strong and fast-setting butyl cyanoacrylates with the flexibility of the octyl cyanoacrylates. An example is LiquiBand (MedLogic Global Ltd., Plymouth, UK).
The nonmedical and medical adhesives contain similar ingredients. The differences between these two types are sterile production, sterile packaging, and the attached alcohol chain in medical grade tissue adhesives. Converting a methyl to an octyl group reduces the heat produced by polymerization and decreases the amount of direct tissue inflammation caused by the breakdown products of the adhesive.1,3
The major advantage to the use of tissue adhesives is speed. Wounds can be repaired quickly and without anesthesia. Tissue adhesives have been shown to offer similar wound closure and cosmetic results as sutures and adhesive strips (e.g., Steri-strips).4,18,19,24 The initial tensile strength of wounds repaired with tissue adhesives are not equivalent to wounds closed with sutures.5,6 Within 7 days, however, any differences in tensile strength are no longer present.5,6 The cost to the patient is less for lacerations repaired with tissue adhesives compared to suturing.7,18 This takes into account physician time, procedure time, materials, and repeat visits for suture removal.7,24 There is less need for the painful injection of local anesthetic solution. The risk of a needlestick injury is decreased when not suturing. An additional benefit of tissue ...