What patient education should I provide for using topical skin adhesive (2‑octyl cyanoacrylate, e.g., Dermabond) to close a small (<5 cm), clean, low‑tension laceration on a non‑mobile site such as the face, scalp, or trunk?

Patient Education for Topical Skin Adhesive (Dermabond) Wound Closure

Keep the wound completely dry for the first 24-48 hours, then you may shower normally but avoid soaking the wound, and watch for any signs of infection such as increasing pain, redness, swelling, or discharge. 1, 2

Immediate Post-Application Care

• Do not touch, pick at, or remove the adhesive – it will naturally slough off in 5-10 days as your wound heals 3
• Keep the wound dry for 24-48 hours after application to allow proper bonding and initial healing 1, 2
• Avoid applying any ointments, creams, or lotions directly on or near the adhesive, as these can dissolve the glue prematurely 3
• Protect from excessive heat and direct sunlight during the healing period 3

Bathing and Hygiene

• After 24-48 hours, you may shower and allow water to run gently over the wound 1, 2
• Avoid submerging the wound in bathtubs, swimming pools, or hot tubs until the adhesive has completely fallen off 4
• Pat the area dry gently with a clean towel after showering – do not rub 1

Activity Restrictions

• Return to normal daily activities immediately for most wounds, as the adhesive provides adequate protection 4
• Avoid activities that create excessive tension or stretching at the wound site, particularly in the first 5-7 days 1
• For facial wounds, minimize excessive facial expressions that might stress the closure in the first few days 5

Warning Signs Requiring Immediate Medical Attention

• Increasing pain that is disproportionate to the injury or worsens after initial improvement 1, 2
• Spreading redness around the wound edges 1, 2
• Swelling that increases rather than decreases over time 1, 2
• Purulent (pus-like) discharge or foul odor from the wound 1, 2
• Wound edges separating or opening (dehiscence) – note that tissue adhesives have a higher risk of wound breakdown compared to sutures (RR 3.35), though this remains uncommon 2
• Fever developing after wound closure 6

Expected Healing Timeline

• The adhesive will begin peeling off naturally in 5-10 days – do not attempt to remove it yourself 3
• Complete healing typically occurs within 7-14 days for most simple lacerations 1
• Facial wounds generally heal faster due to excellent blood supply 5

Common Pitfalls to Avoid

• Do not apply bandages or dressings over the adhesive unless specifically instructed, as the glue itself serves as the protective barrier 4
• Do not use hydrogen peroxide or alcohol on the wound, as these can break down the adhesive prematurely 3
• Do not attempt to "help" the adhesive come off by picking or peeling at it 3

Long-Term Cosmetic Outcomes

• Cosmetic results with skin adhesive are comparable to sutures for appropriate low-tension wounds, with patient satisfaction typically very high 7, 8
• Facial wounds closed with adhesive show equivalent or superior cosmetic outcomes at 1-year follow-up compared to traditional sutures 8
• No suture removal appointment is needed, which eliminates the discomfort and inconvenience of suture removal 1

Special Considerations

• The adhesive is for external use only and should not contact mucous membranes or the inside of the wound 3
• If you have concerns about healing, contact your healthcare provider rather than attempting to intervene yourself 1, 2
• Pain disproportionate to injury severity may indicate deeper complications requiring evaluation 2