The Benefits of Topical Adhesives
It can happen to the best of us. You’re slicing onions for a stir fry and the knife slips, or you’re in a hurry, trip on a curb and fail to break your fall.
Each year, millions of people enter healthcare facilities with wounds that need to be closed medically. In fact, traumatic lacerations are one of the most common reasons people show up in Emergency Departments; more than 7 million cases occur each year, costing upwards of $3 billion.
In addition, between 26 and 90 million surgical incisions take place annually, which means there are a lot of wounds that require closure by emergency room physicians, primary care doctors and surgeons.
Traditionally, wounds have been closed using a variety of methods including sutures, surgical tape and staples. One method that is gaining in popularity involves the use of topical cyanoacrylate tissue adhesives – commonly referred to as “liquid stitches” or “topical adhesives” – which close wounds using a glue that holds the broken skin together. One common formulation of cyanoacrylate, known as octyl-2-cyanocrylate, offers some benefits over alternative wound closure methods including:
- Less time closing the wound: Studies, including one large randomized controlled trial of over 900 lacerations and surgical incisions, have shown that wound closure of lacerations and surgical incisions was faster with octlycyanocrylate versus other closure methods. In surgical situations, this can mean less time in the operating room for the patient and surgeons.
- Lower risk of surgical site infections: Using octyl-2-cyanocrylate to close surgical incisions can limit the risk of surgical site infections (SSIs) by effectively isolating the incision site. One longitudinal study showed that using octyl-2-cyanocrylate along with obtaining sufficient approximation of the wound’s edges with cutaneous or subcutaneous sutures, lowered surface tension and protected the site from external contamination.
- Less pain: A reduction in pain is something most patients care about. To this end, using an adhesive is a relatively painless process, which in many cases means that a local anesthetic can be avoided. This can be especially important when dealing with traumatic lacerations in children who can be afraid of needles. In addition, because the adhesive typically detaches itself between 5 and 11 days after the procedure, there is no need to physically remove them, which further helps to avoid additional pain or needle sticks.
- Saving time on patient follow ups: Octyl-2-cyanocrylate can reduce not only the amount of time to close the wound, but also lower the number of post-operative visits needed and the length of the follow-up appointments themselves. One study of 450 patients showed that a total 375 hours were saved, freeing up valuable time for healthcare professionals.
- Cosmetically more appealing: Due to the fact that the healthcare practitioner closing the wound may be able to avoid using sutures, this means that it also eliminates the formation of suture marks on either side of the wound. This can be appealing for patients who want minimal long-term evidence of the injury.
While cyanoacrylates adhesives offer benefits in many wound situations, there are limitations as well. These are mainly that they possess a lower tensile strength than sutures and have limited moisture resistance. Another consideration, though not common, is that cyanoacrylate topical skin adhesives can cause allergic skin reactions in patients with sensitivities to cyanoacrylates or formaldehyde.
There is also a variety of adhesive types available with different qualities, so be sure to pay attention to the features before making a decision. Some features to consider are:
- Flexibility and water resistance
- Barrier level to microbial contamination
- Amount of adhesive needed to obtain appropriate closure
- Level of exothermic reaction in patients
- How much user control there is during the application
While there will remain a variety of ways for healthcare practitioners to close the millions of wounds and incisions they treat each year, topical adhesives offer a number of benefits that can help to decrease SSIs, free up staff time and create a more pleasant patient experience.