Tissue Adhesive

On clean lacerations under low tension in dry areas, skin adhesives are an appropriate substitute for standard suturing materials and methods. Adhesives may also work on shallow, irregular, beveled lacerations and are useful on pediatric scalp lacerations. Since 1998, the long-chain medical tissue adhesive, 8-carbon 2-octylcyanoacrylate (OCA), has been available in the United States for tissue adhesive closure of wounds. OCA is more durable and flexible than the short-chain butylcyanoacrylates. The long-chain cyanoacrylates create less dehiscence in wounds longer than 8 cm. Avoid adhesive use in moist or hairy areas, on mucous membranes, if hemostasis is required, over joints or highly mobile tissue, and in bite wounds or dirty lacerations. Consider the adhesives to have about the same strength as 5.0 sutures. If OCAs are used, the patient may shower immediately, but if the butylcyanoacrylates are used, the repaired wound should be kept dry for at least 48 hours. Moisture exposure increases dehiscence risk (Singer and Dagum, 2008). If the area to repair is under higher tension, deep sutures to approximate the skin edges before closing with a superficial adhesive results in better outcomes (Singer and Thode, 2004).

Tissue adhesive agents form their own bandage, and no additional care is needed. Full tensile strength is achieved after 2V2 minutes. Because antibiotic and white petrolatum ointments can remove tissue adhesive, patients must be instructed to avoid using these on the repaired wound (Forsch, 2008).

Dehiscence occurred on 2.5% of wounds closed with tissue adhesives in an animal study comparing 2-cm and 10-cm laceration repairs with adhesive versus various suture types and different stitches. In the 2-cm wounds, results were identical. The 10-cm wounds favored deep suturing even if tissue adhesive was used. The final decision on the method and materials used for wound closure depends on the length and location of the wound as well as the time for closure and efficiency of closure (Zeplin et al., 2007). (See Tuggy Video: Tissue Glue.)

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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