INTRODUCTION/BACKGROUND
- Dermabond is a cyanoacrylate adhesive: Combines cyanoacetate and formaldehyde with a base to form a liquid
- Forms a cyanoacrylate bridge with the skin's moisture, binding the wound edges together
- Is a flexible water-resistant protective coating
- Healing occurs below skin level
- No need for adhesive removal
- Meant to replace sutures 5-0 or smaller
- Advantages over sutures
- Maximum strength at 2½ minutes
- Equivalent in strength to healed tissue at seven days post-repair
- Can be applied using only a topical anesthetic, no needles
- Water-resistant covering
- Does not require removal of sutures.
UNIVERSAL PRECAUTIONS
- Gloves must be worn
- Evaluate the need for face and eye protection as well as a gown
- Only the necessary amount of adhesive should be used
- Excess adhesive must be quickly removed.
- Introduce yourself to the patient
- Explain the procedure to the patient and gain informed consent to continue
- Explain that the adhesive may produce a sensation of heat while drying.
INDICATIONS
- Properly selected wounds on the face, extremities and torso may be closed up to the discretion of the physician
- Extremity and torso wounds tend to heal better when subcutaneous sutures are placed first
- If areas of high tension or mobility, splint to prevent premature peeling
- No need for follow-up.
CONTRAINDICATIONS
- Jagged or stellate lacerations
- Bites, punctures or crush wounds
- Contaminated wounds
- Mucosal surfaces
- Axillae and perineum (high-moisture areas)
- Hands, feet and joints (unless kept dry and immobilized).
COMPLICATIONS
- Immediate complications
- Hematoma formation
- Wound infection
- Excess adhesive
- Edges misaligned
- Glued eyelids
- Late complications
- Dehiscence
- Scar formation.
BASIC EQUIPMENT
- Gauze
- Vial of dermabond
- Antiseptic
- Topical anesthetic.
- Ensure wound irrigation and cleansing
- Clean smaller lacerations with antibacterial and flush with sterile saline solution
- Deeper wounds should undergo these same steps but may also require subcutaneous sutures to strengthen the wound closure.
PROCEDURE STEPS
- Apply topical anesthetic as needed
- Prepare wound with antiseptic
- Appose wound edges
- Crush Dermabond vial and invert
- Gently brush adhesive over laceration
- Avoid pushing adhesive into wound
- Apply three layers of adhesive
- No covering is needed
- No removal necessary.
1. What is an appropriate adhesive site?
- Elbow
- Knuckle
- Labia
- Scalp
2. What does the adhesive use to bond to the skin?
- Skin moisture
- Saline
- Antiseptic
- Anesthetic
3. Which of the following is not an indication for skin adhesion?
- Wound with minimal tension
- Moist location of wound
- Edges that are easily approximated
- Smooth edged wound
4. How is skin adhesive removed when the eyelid is glued shut?
- Force eyelids open
- Warm the eyelids and it will release in 2 hours
- Apply ointment and it will release in 3 days
- Take the patient to surgery and cut the eyelid open
5. To what wound depth should the adhesive be applied?
- Surface only
- 2 cm below surface
- 5 cm below surface
- Full depth of laceration
Answers | ||||
1. d | 2. a | 3. b | 4. c | 5. a |
- Bruns TB, Robinson BS, Smith RJ, et al. A new tissue adhesive for laceration repair in children. J Pediatr. 1998;132:1067–70.
- Bruns TB, Simon HK, McLario DJ, Sullivan KM, Wood RJ, Anand KJ. Laceration repair using a tissue adhesive in a children's emergency department. Pediatrics. 1996;98:673–5.
- Edlich RF Tissue adhesives‒revisited. Ann Emerg Med. 1998;31:106–7.
- Quinn J, Wells G, Sutcliffe T. et al. Tissue adhesive versus suture wound repair at 1 year: Randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med. 1998;32:645–9.
- Quinn JV, Drzewiecki A, Li MM, Stiell IG, Sutcliffe T, Elmslie TJ, et al. A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann Emerg Med. 1993;22:1130–5.
- Quinn JV, Wells GA. An assessment of clinical wound evaluation scales. Acad Emerg Med. 1998;5:583–6.
- Simon HK, McLario DJ, Bruns TB, Zempsky WT, Wood RJ, Sullivan KM. Long-term appearance of lacerations repaired using a tissue adhesive. Pediatrics. 1997;99:193–5.
- Singer AJ, Hollander JE, Valentine SM, Thode HC Jr, Henry MC. Association of training level and short-term cosmetic appearance of repaired lacerations. Acad Emerg Med. 1996;3:378–83.
- Singer AJ, Hollander JE, Valentine SM, Turque TW, McCuskey CF, Quinn JV. Prospective, randomized, controlled trial of tissue adhesive (2-octylcyanoacrylate) vs. standard wound closure techniques for laceration repair. Acad Emerg Med. 1998;5:94–9.
- Toriumi DM, O'Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg. 1998;102:2209–19.