What is the proper use and application of skin glue for wound closure?

Proper Use and Application of Skin Glue for Wound Closure

Sutures are significantly better than tissue adhesives for minimizing wound dehiscence, though skin glue offers advantages of quicker application and comparable outcomes for infection rates, patient satisfaction, and cosmetic appearance. 1

Indications and Benefits of Skin Glue

• Skin glue (cyanoacrylate tissue adhesive) is most appropriate for small, clean incisions and lacerations, offering excellent cosmetic results with high patient satisfaction 2
• Advantages include quick application, no risk of needle sticks, and elimination of the need for suture removal 2, 3
• Particularly useful for laparoscopic wound closure, with extremely low infection rates (1%) and excellent cosmetic results 2, 4
• FDA-approved primarily for skin cuts and lacerations, with expanding applications in various surgical situations 3

Proper Application Technique

• Ensure wound edges are clean and dry before application 3
• Approximate wound edges precisely before applying the adhesive, as poor approximation can lead to partial dehiscence 2
• Apply the adhesive over the approximated wound edges, avoiding introduction into the wound itself 3
• Allow the adhesive to polymerize completely (typically 30-45 seconds) before releasing wound edges 3
• Consider applying multiple thin layers rather than one thick layer for optimal strength 3

Strength and Efficacy Considerations

• Skin glue provides wound closure strength similar to interrupted subcuticular absorbable sutures 5
• However, staples provide the strongest closure, with skin glue being superior to adhesive strips (Steri-Strips) but inferior to stapled closure 5
• Use caution when applying skin glue to areas of the body subject to tension, as failure typically occurs at the skin-glue interface 5
• A Cochrane review of 33 studies (2793 participants) found sutures significantly better than tissue adhesives for reducing wound breakdown risk (RR 3.35; 95% CI 1.53-7.33) 1

Comparative Outcomes

• Cosmetic results between adhesive and suture-treated skin incisions show no significant difference in controlled comparative studies 6
• Morphologically, glue-treated wounds may have a lower tendency to develop abscesses or major inflammation compared to sutured wounds 6
• For infection, patient satisfaction, and cost outcomes, there is no evidence of significant differences between sutures and tissue adhesives 1
• The number needed to treat for an additional harmful outcome (dehiscence) with tissue adhesives versus sutures is calculated as 43 1

Limitations and Contraindications

• Not recommended for high-tension areas or wounds with poor edge approximation 5
• Should be used with caution in contaminated wounds 2
• Not suitable for mucosal surfaces or areas with high moisture content 3
• Avoid use in patients with known hypersensitivity to cyanoacrylate or formaldehyde 3

Post-Application Care

• Keep the wound clean and dry for the first 24-48 hours after application 7
• No suture removal is required, as the adhesive naturally sloughs off as the wound heals 3
• Monitor for signs of infection such as increasing pain, redness, swelling, or discharge 7
• Pain disproportionate to the severity of injury may suggest deeper complications 7