Urgent Procedures in Medical Practice Sanja Kupesic Plavsic
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Skin AdhesivesCHAPTER 1

Pathak I
 
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.
 
2OBTAIN INFORMED CONSENT
  • 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.
 
3PREPARATION
  • 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.
SELF-ASSESSMENT QUIZ
1. What is an appropriate adhesive site?
  1. Elbow
  2. Knuckle
  3. Labia
  4. Scalp
2. What does the adhesive use to bond to the skin?
  1. Skin moisture
  2. Saline
  3. Antiseptic
  4. Anesthetic
3. Which of the following is not an indication for skin adhesion?
  1. Wound with minimal tension
  2. Moist location of wound
  3. Edges that are easily approximated
  4. Smooth edged wound
4. How is skin adhesive removed when the eyelid is glued shut?
  1. Force eyelids open
  2. Warm the eyelids and it will release in 2 hours
  3. Apply ointment and it will release in 3 days
  4. Take the patient to surgery and cut the eyelid open
5. To what wound depth should the adhesive be applied?
  1. Surface only
  2. 2 cm below surface
  3. 5 cm below surface
  4. Full depth of laceration
Answers
1. d
2. a
3. b
4. c
5. a
4SUGGESTED READING
  1. Bruns TB, Robinson BS, Smith RJ, et al. A new tissue adhesive for laceration repair in children. J Pediatr. 1998;132:1067–70.
  1. 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.
  1. Edlich RF Tissue adhesives‒revisited. Ann Emerg Med. 1998;31:106–7.
  1. 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.
  1. 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.
  1. Quinn JV, Wells GA. An assessment of clinical wound evaluation scales. Acad Emerg Med. 1998;5:583–6.
  1. 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.
  1. 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.
  1. 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.
  1. 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.