January 13, 2025 | Net Health

8 min read

Sealing the Deal: Wound Glue’s Role in Treatment

Wound glue, also known as wound adhesive, has changed the way healthcare professionals close wounds. This alternative to sutures and staples provides a quick, painless, and effective method for treating cuts, lacerations, and surgical incisions. Over the past several years, wound glue has grown popular in emergency rooms, operating rooms, and primary care clinics.

While it seems like a novel concept, wound glue has been around for centuries. The ancient Egyptians used honey and sutures to close and dress wounds and prevent infection. In today’s modern world, wound glues are much more sophisticated and have a much more complex structure. The first cyanoacrylate-based tissue adhesive was developed in the 1940s, but it wasn’t until the 1990s that the FDA approved it for wound closure in the United States. 

Wound Glue: Types and Benefits

There is not a universal solution for every type of wound because each treatment has its own advantages and limitations. Surgeons typically choose sutures because of their great tensile strength and low failure rate. One of the main issues that sutures present is the numerous punctures to surrounding tissue from the needle – this is a particular problem for children, and those who are needle phobic. In many cases, sutures are time consuming, particularly for long lacerations.

Cyanoacrylate adhesives were first used back in 1959 and are now becoming a first line treatment for cuts and lacerations. These adhesives offer comparable tensile strength to that of sutures and are capable of adhering to most tissue surfaces.

There are several types of wound glues available on the market, each with its own unique properties.

  1. Octyl-2-cyanoacrylate (Dermabond): This is one of the most commonly used wound glues. Several studies have shown increased bursting strength compared to the butyl-cyanoacrylates. In fact, its bursting strength increases the day after application, suggesting that it cures over time. Dermabond is the only adhesive that did not fracture during the three days of the study. 
  2. Butyl-cyanoacrylate (Histoacryl, Indermil): These have not achieved widespread use in the United States but still offer good tensile strength, although less than that of Dermabond.
  3. N-butyl-2-cyanoacrylate (Periacryl): This adhesive is often used in dental procedures and for internal surgical applications.
  4. 2-octyl cyanoacrylate (SurgiSeal): Similar to Dermabond, this adhesive is designed for topical skin closure.
  5. Fibrin sealants: Derived from human plasma, these are used in various surgical procedures, especially if suturing is difficult. 

Benefits of Wound Glue

Wound glue offers numerous advantages over traditional wound closure methods in application, reduced infection, and the ability to return to normal activity sooner.

Application

The speed with which wound glue can be applied is a huge advantage over traditional sutures. This is particularly helpful in busy emergency departments or when dealing with uncooperative patients. Its painless application makes it an excellent option for young children or adults who are needle phobic.

Reduced Infection

Due to the liquid nature of the glue, the entire wound surface is sealed. This helps create a barrier against bacteria and can lead to lower infection rates compared to sutures. Once the wound glue dries, a waterproof barrier is created, allowing patients to bathe or shower without worrying about getting the wound wet.

Return to Normal Activity

Because of its flexible, waterproof seal, patients can often return to normal activities much sooner than with traditional wound closure methods. Also, the wound glue normally becomes soft after about five to 10 days, eliminating the need for a follow-up appointment to remove stitches, saving time for patients and healthcare providers. One can also argue that although the initial cost of the glue is more than that of sutures, the overall cost may be lower due to the decreased need for follow-up appointments for suture removal.

wound glue is used to close a child's wound

Wound Glue Application: Methods, Considerations and Contraindications

Application Process

For wound glue to be effective, it is essential to apply it carefully, keeping the following guidelines in mind.

  1. Assessing the wound is important to determine if it can be effectively sealed. Factors to take into account include the size of the wound, its depth, and cleanliness.
  2. Clean the wound carefully and ensure that the wound and the skin around it are completely dry, before proceeding. It may be necessary to debride the wound before assessing, if there is enough dead or infected tissue to obscure the wound.
  3. Ensure that bleeding is under control before using the adhesive, as any ongoing bleeding can disrupt the bonding process. 
  4. Approximate the wound edges close using either your fingers or forceps, making sure that the skin edges are properly aligned. 
  5. Spread an amount of glue on the edges of the wound, making sure not to let it seep into the actual wound itself. 
  6. Apply a few coats of glue in succession – let each coat dry for half a minute before moving on to the next one. 
  7. Hold the wound together by keeping the edges close for around a minute after applying the layer to allow for bonding. 
Considerations for Use

Wound glue is an excellent option for most wounds. However, it is not suitable for all situations. Before using it, consider the following parameters.

Wound Size, Depth, and Location

Wound glue is ideally used for small wounds, those less than four to five cm in length. Larger wounds may require sutures in place of or in addition to the use of wound glue. It’s also designed for superficial wounds, unlike deep wounds, or those in multiple layers, which usually require sutures or staples. Avoid using wound glue on high-tension areas such as joints, hands, feet, or areas with a lot of movement, as these areas may cause the glue to break down prematurely.

Wound Age and Cleanliness

You can only treat the wounds that come to you, and in some cases, patients don’t make it to you in a timely manner. Wound glue should be used on wounds that are less than 12 hours old; wounds that are older than this are at higher risk for infection and, therefore, less suitable for its use. Heavily contaminated wounds or those at high risk for infection are unsuitable candidates for wound glue.

Patient Factors

Prior to using wound glue, the patient’s age, overall health, and ability to follow aftercare instructions need to be considered. Although rare, those who are allergic to cyanoacrylates or formaldehyde should not be treated with wound glue. While the cosmetic results from wound glue are often acceptable for wounds in highly visible areas or where scarring is a concern, traditional suturing may be preferred.

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Contraindications

There are several situations where wound glue should not be used, including:

  1. Mucosal surfaces or wet areas (e.g., inside the mouth)
  2. Areas of high skin tension (e.g., over joints)
  3. Wounds with active bleeding
  4. Deep puncture wounds
  5. Animal or human bites
  6. Wounds in areas with dense hair growth
  7. Patients with known allergies to cyanoacrylates or formaldehyde
  8. Wounds showing signs of infection or gangrene
Aftercare and Potential Complications

Patient Instructions

Patients typically need to know less in order to treat a wound closed with wound glue at home compared to those closed with sutures or staples; however, certain guidelines still need to be followed to ensure optimal healing.

  1. Keep the wound dry, especially for the first 24 to 48 hours. After this, brief exposure to water, such as during bathing, is acceptable, but prolonged soaking should be avoided.
  2. Avoid picking at the wound, as this may delay healing. The patient should be reassured that the wound will normally slough off within five to 10 days.
  3. Avoid ointment, as these can cause the glue to break down prematurely.
  4. Protect the wound if needed with a non-adherent dressing.
  5. Restrict activities that could cause the wound to reopen, especially during the first few days.
  6. Contact health care professionals if they experience any signs of an infection, such as increased pain, redness, swelling, or discharge from the wound.

Potential Complications

As a rule, wound glue is generally safe and effective; however, as with any medicine, there are potential complications. Wound dehiscence can occur if the wound is under too much tension or the adhesive is applied incorrectly. Infection, while rare, can still occur; proper wound-cleaning techniques and patient aftercare are still required. Allergic reactions can range from mild skin irritation to more severe reactions such as anaphylaxis. Questioning patients about their allergies, especially for formaldehyde or cyanoacrylate, can reduce this risk. Delaying healing can occur with improper application or premature removal of the adhesive. The curing process of some glues can generate heat, which can cause discomfort in patients, but this is usually self-limiting.

Recent Advances and Future Directions

Researchers are actively exploring formulations for wound adhesives to enhance the healing process. In addition to improving dressings’ effectiveness, scientists are working toward creating adhesives with features and innovative properties, like color-changing abilities, to provide insights into the wound’s condition. There is also research into developing adhesives that could gradually break down, potentially enabling their use in internal medical applications. The combination of dressings and wound adhesives shows promise for simplifying wound care. As flexibility has been a drawback for adhesives, research has been concentrating on developing adhesives with improved flexibility, allowing their use in more areas of the body.

Closing the Gap: Wound Glue’s Adventure Continues

Wound glue has certainly made an impact in health care by offering numerous benefits for both health care providers and patients. Its speed of application, painless nature, and cosmetic results make it a great option for many types of wounds. As noted above, however, proper patient selection and careful application techniques are necessary for consistent results. As research continues, wound adhesives will continue to evolve, expanding their application in wound management across all specialties.

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