Indications and Contraindications for Wound Glue (Tissue Adhesive)
Tissue adhesives are indicated for clean, superficial lacerations under low tension that can be easily approximated to within 5mm, providing equivalent cosmetic outcomes to sutures with less pain and faster application time. 1, 2
Primary Indications
Wound glue is appropriate when ALL of the following criteria are met:
- Low-tension wounds where edges can be easily approximated without excessive force 1, 3, 2
- Small to moderate lacerations (typically <3 cm average length, though larger wounds may be suitable if subcutaneous sutures reduce tension first) 2, 4
- Superficial wounds that do not require deep tissue repair beyond subcutaneous support 3, 5
- Clean wounds that have been thoroughly irrigated with copious water or sterile normal saline 3
- Dry wound base - the area must be completely dry for proper adhesion 1, 3
- Well-approximated edges that can be brought together to within 5mm 2
Specific Anatomical Considerations
- Facial lacerations (including forehead) are particularly well-suited for tissue adhesive, especially in pediatric patients 1, 4, 6
- Finger injuries can be managed with tissue adhesive when low-tension criteria are met 3
- Areas subject to high tension should be approached with caution, as tissue adhesive provides inferior strength compared to staples and may be comparable to subcuticular sutures 7
Absolute Contraindications
- High-tension wounds where tissue adhesive will not provide adequate strength - consider plastic surgery or traditional suturing 1, 3, 2
- Wounds that cannot be easily approximated - alternative treatments such as plastic surgery should be considered 1
- Moist or contaminated wound bases - moisture prevents proper adhesion 1, 3
- Patients with factors delaying wound healing - traditional suturing is preferred 1, 3
Relative Advantages Over Sutures
- Significantly less pain (Parent VAS reduction of 15.7 mm on 100mm scale) 8
- Faster procedure time (approximately 5.7 minutes faster than sutures, with application taking 1-2.5 minutes) 4, 8
- No suture removal required - eliminates follow-up visit for removal 5, 6
- Water-resistant protective coating that allows normal activities 5
- Better patient acceptance, particularly in children with needle phobia 5, 6
- Equivalent cosmetic outcomes to traditional suturing at long-term follow-up 1, 5, 8
Important Complications and Limitations
- Higher dehiscence rate compared to sutures (Number Needed to Harm = 25), though absolute risk remains low 8
- Wound dehiscence risk is higher in high-tension areas where tissue adhesive may fail at the skin-glue interface 7
- Lower tensile strength than staples, though comparable to subcuticular absorbable sutures 7
Proper Application Technique
- Ensure adequate lighting and analgesia before beginning the procedure 1
- Clean and de-epithelialize wound edges to create a compact base for better adhesion 3
- Dry the wound base completely - this is critical for proper adhesion 1, 3
- Apply minimal adhesive using a 30-gauge needle, wooden end of cotton applicator, or micropipette 1, 3
- Consider Steri-Strips across the wound for additional support during healing 1, 3