What are the guidelines for using skin glue (cyanoacrylate) for wound closure?

Guidelines for Using Skin Glue (Cyanoacrylate) for Wound Closure

Skin glue (cyanoacrylate) should be used primarily for small, superficial lacerations with well-approximated edges, and should not be applied to infected wounds, mucosal surfaces, or areas of high tension or mobility.

Appropriate Indications for Skin Glue

• Ideal wound characteristics:

  • Small, superficial lacerations (suitable for 5-0 sutures or smaller)
  • Clean wounds with minimal contamination
  • Well-approximated wound edges
  • Low-tension areas
  • Facial wounds where cosmetic outcome is important 1

• Benefits of skin glue:

  • Faster application than traditional suturing
  • Water-resistant protective coating
  • Eliminates need for suture removal
  • Comparable long-term cosmetic outcomes to traditional methods
  • Better patient acceptance, especially in children 1

Contraindications and Precautions

• Do not use skin glue in:

  • Infected wounds
  • Mucosal surfaces or wet areas
  • Areas with high tension or mobility
  • Patients with known allergy to cyanoacrylate 2, 3

• Important precautions:

  • For external use only 2
  • Do not use on broken or damaged skin 2
  • Be aware of potential for contact dermatitis (incidence up to 14% in some studies) 3
  • Avoid application of superglue (ethyl cyanoacrylate) to inflammatory or healing fissures 4

Proper Application Technique

1. Wound preparation:

   • Clean the wound thoroughly
   • Ensure complete hemostasis
   • Dry the wound completely (adhesive won't adhere to wet surfaces) 4
   • Debride if necessary

2. Application method:

   • Approximate wound edges precisely
   • Apply thin layer of adhesive over the apposed wound edges
   • Allow 30-60 seconds for polymerization
   • Apply additional layers as needed (usually 3-4 layers total)
   • Avoid getting adhesive inside the wound 1

3. Post-application care:

   • Keep the wound dry for 24-48 hours
   • No need for additional dressings in most cases
   • Adhesive naturally sloughs off in 5-10 days 1

Special Considerations

• For larger wounds:

  • Consider using deep dermal sutures first, then skin glue for superficial closure 1
  • Ensure wound edges are perfectly aligned before applying glue

• Ophthalmologic applications:

  • Can be used for small corneal perforations or descemetoceles
  • Apply minimal amount to seal defect
  • Use sterile product to reduce infection risk
  • Cover with bandage contact lens to prevent dislocation 4

• Potential adverse reactions:

  • Contact dermatitis (more common than previously thought)
  • Tissue toxicity if applied within wound
  • Foreign body reaction 3

Patient Education

• Instruct patients to:
  • Keep the wound dry for 24-48 hours
  • Avoid picking at the adhesive
  • Return if signs of infection develop (redness, warmth, increasing pain, purulent drainage)
  • Watch for signs of allergic reaction (excessive redness, itching, rash beyond wound edges)
  • Understand that the adhesive will naturally slough off in 5-10 days

Conclusion

Skin glue provides an excellent alternative to traditional suturing for appropriate wounds. When used correctly, it offers comparable cosmetic outcomes with faster application times and improved patient comfort. However, proper patient selection and application technique are essential for optimal results.