What are the parameters of use for Dermabond (2-octyl cyanoacrylate)?

Parameters of Use for Dermabond (2-octyl cyanoacrylate)

Dermabond is most appropriate for closure of small, superficial lacerations where traditional sutures of 5-0 or smaller would be used, and should be applied after proper wound preparation to clean, dry, and de-epithelialized surfaces. 1

Appropriate Uses

• Wound Types:

  • Small, superficial lacerations
  • Low-tension wounds
  • Lacerations requiring minimal closure force 2
  • Can be used with confidence on larger wounds where subcutaneous sutures are needed 1

• Specific Applications:

  • Pediatric laceration repair (well-accepted by children) 1
  • Facial wounds that must be sutured (to avoid pain of suture removal) 2
  • Progressive corneal thinning or small perforations 2
  • Small areas of marked thinning or early descemetocele in ophthalmology 2

Contraindications

• Active infections at the site (e.g., impetigo, herpes) 2
• Open wounds with gross contamination 2
• High-tension areas or wounds under significant mechanical stress
• Mucosal surfaces or areas with high moisture content
• Areas with dense hair
• Ballooning descemetocele (not suitable) 2

Application Technique

1. Wound Preparation:

   • Clean and irrigate the wound thoroughly
   • Achieve hemostasis before application
   • Ensure the area is completely dry (critical for proper adhesion) 2
   • De-epithelialize the wound edges if needed 2

2. Application Methods:

   • Apply using a 30-gauge needle
   • Wooden end of cotton applicator
   • Micropipette 2
   • Apply the least amount of glue necessary to seal or support the defect 2

3. Post-Application Care:

   • Apply bandage contact lens after corneal applications to prevent dislocation of glue and provide comfort 2
   • Forms a flexible water-resistant protective coating 1
   • No need for suture removal 1

Clinical Benefits

• Time Efficiency:

  • Faster wound closure compared to sutures (155 seconds vs 286 seconds for subcuticular closure) 3
  • Eliminates need for suture removal 1

• Antimicrobial Properties:

  • Demonstrates bactericidal properties against Gram-positive bacteria 4
  • May reduce postoperative wound infection by Gram-positive organisms 4
  • Acts as a physical barrier to bacteria accessing the wound 4

• Patient Experience:

  • Better accepted by patients, especially children, compared to traditional suturing 1
  • Water-resistant barrier allows normal bathing 1

Potential Complications

• Wound Issues:

  • Higher wound complication rates compared to subcuticular closure in some surgical applications 3
  • May not provide optimal cosmesis compared to subcuticular sutures in certain applications 3

• Application Challenges:

  • Requires dry field for proper adhesion
  • Tissue adhesive will work best when the area of impending perforation is small and at the bottom of a crater 2

Duration of Effect

• Can remain in place for up to 6 weeks or longer if applied to a clean and compact base 2
• Allows normal healing to occur beneath the adhesive 1

Special Considerations

• For corneal perforations, leaking descemetoceles may require injection of an air bubble into the anterior chamber to halt leakage temporarily while glue is applied 2
• Not FDA-approved for use on the eye, but has been widely used for many years in ophthalmology 2
• Do not use fibrin glue for corneal perforations or descemetoceles as it biodegrades too rapidly before healing can occur 2

Dermabond provides an effective alternative to traditional suturing for appropriate wound types, with benefits including faster application, elimination of suture removal, antimicrobial properties, and better patient acceptance.