How to apply Derma bond (cyanoacrylate) to a wound bed?

Proper Application of Dermabond (Cyanoacrylate) to Wound Beds

Dermabond should not be applied directly to wound beds but rather used to seal approximated wound edges after proper wound preparation and closure.

Appropriate Use of Dermabond

Dermabond (2-octylcyanoacrylate) is a tissue adhesive designed specifically for closing the edges of wounds, not for application to open wound beds. The proper application involves:

1. Wound Preparation:

   • Clean the wound thoroughly with sterile saline or water 1
   • Ensure complete hemostasis before application 2
   • Debride any necrotic tissue if present 1

2. Wound Closure:

   • Approximate wound edges precisely 2
   • For larger wounds, use deep dermal sutures first to reduce tension 2, 3
   • Ensure the wound is completely dry before applying adhesive

3. Dermabond Application:

   • Apply the adhesive over the approximated edges, not into the wound bed
   • Apply multiple thin layers rather than one thick layer 2
   • Extend application 5-10mm beyond wound edges for better sealing
   • Hold edges together for 30-60 seconds until polymerization occurs

Contraindications for Dermabond

• Open wound beds (the primary contraindication)
• Mucosal surfaces or across mucocutaneous junctions
• Areas of high tension or high mobility
• Infected wounds
• Wounds in patients with known hypersensitivity to cyanoacrylates

Alternative Approaches for Wound Beds

For actual wound bed management, guidelines recommend:

1. Proper Wound Bed Preparation:

   • Regular cleaning with water or saline 1
   • Control of exudate to maintain moist wound environment 1
   • Regular debridement to remove necrotic tissue 1

2. Appropriate Dressing Selection:

   • Use sterile, inert protective dressings for most wounds 1
   • For exudative wounds: alginates or foams 4
   • For necrotic wounds: hydrogels 4
   • For dry wounds: films or hydrocolloids 4

3. Advanced Wound Therapies (when appropriate):

   • Negative pressure wound therapy for post-operative wounds 1
   • Consider hyperbaric oxygen therapy for diabetic foot ulcers 1

Common Pitfalls to Avoid

1. Never apply Dermabond directly into open wound beds - this can delay healing and cause foreign body reactions
2. Avoid excessive application - thick layers can generate excessive heat during polymerization
3. Don't use on infected wounds - can seal in bacteria and worsen infection
4. Avoid use on high-tension areas without deep suture support

Clinical Applications

Dermabond is best suited for:

• Small, superficial lacerations
• Surgical incisions where 5-0 or smaller sutures would be used 2
• As a protective coating over properly closed wounds 5
• In combination with Tegaderm for vascular surgery incisions to reduce infection risk 5

By following these guidelines, you can ensure proper use of Dermabond for wound closure while avoiding complications associated with inappropriate application to wound beds.