Application of Dermabond for Skin Fillet
For skin fillet management, Dermabond (2-octyl cyanoacrylate) should be applied as a thin layer to a completely dry, clean wound base, using a 30-gauge needle, wooden end of a cotton applicator, or micropipette, with the minimum amount necessary to seal the defect.
Preparation of the Wound Site
- Ensure the wound is thoroughly cleaned and irrigated
- Achieve complete hemostasis before application
- De-epithelialize wound edges if necessary
- Ensure the area is completely dry - this is critical for proper adhesion 1
- Remove any crusts with gauze soaked in saline 2
Application Technique
- Apply the smallest amount of Dermabond necessary to seal or support the defect 2
- For skin fillets:
- Use a 30-gauge needle, wooden end of cotton applicator, or micropipette for precise application 2
- Apply a thin, even layer over the wound surface
- Avoid allowing the adhesive to run into the wound or onto surrounding healthy tissue
- Hold wound edges in approximation for 30-60 seconds to allow initial setting
Post-Application Care
- Apply a non-adherent dressing over the glued area if needed 2
- Dermabond can remain in place for up to 6 weeks if applied to a clean and compact base 2
- Monitor for signs of infection or dehiscence
- Keep the area clean and dry for 24-48 hours after application
Advantages of Dermabond for Skin Fillets
- Forms a strong bond across apposed wound edges 3
- Provides a flexible water-resistant protective coating 3
- Acts as an effective microbial barrier with 95% confidence of 99% efficacy for 72 hours 4
- Saves time during wound repair compared to traditional suturing 3, 5
- Eliminates the need for suture removal 3
Contraindications and Limitations
- Not recommended for:
- Actively infected wounds
- Heavily contaminated wounds
- High-tension areas or wounds under significant mechanical stress
- Mucosal surfaces
- Areas with high moisture content
- Areas with dense hair 1
Clinical Pearls
- For best results, ensure the wound base is completely dry before application
- Apply the minimum amount necessary - excessive application can lead to thermal injury or delayed healing
- If the fillet is peripheral, Dermabond may serve as definitive treatment; if central, it facilitates non-emergent repair 2
- Unlike fibrin glue, Dermabond does not biodegrade rapidly, making it suitable for wounds requiring longer-term support 2
- A Cochrane review found that sutures are better than tissue adhesives for reducing wound dehiscence, but there was no difference in infection rates, patient satisfaction, or cosmetic outcomes 2
By following these guidelines, Dermabond can be effectively used for skin fillets, providing a quick, water-resistant closure that protects against microbial invasion while allowing normal healing to occur beneath.