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PubMed1993

The use of tissue adhesion for traumatic laceration repair in the emergency department.

STUDY OBJECTIVE: To characterize the role of tissue adhesion as an adjunct in wound closure. DESIGN: Patients were subjectively selected for tissue adhesion and assessed for efficiency, pain, complications, and cost effectiveness. SETTING: The TEREM Immediate Medical Care Center Emergency Department in Jerusalem, Israel. TYPE OF PARTICIPANTS: Patients with traumatic lacerations requiring wound closure. MEASUREMENTS AND MAIN RESULTS: Lacerations considered appropriate for tissue adhesion tended to involve the scalp, chin, and forehead and were relatively shorter. The complication rate was low. This technique was painless, reduced the need for follow-up care, eliminated the need for local anesthesia and suture-removal visits, and was cost effective. Patients indicated a high level of satisfaction with tissue adhesion. CONCLUSION: Our report indicates that tissue bonding may be a preferred and cost-effective method of repair of appropriate traumatic lacerations in the ED.

Cyanoacrylates↗

PubMed2005

The use of isobutylcyanoacrylate as a tissue adhesive in abdominal surgery.

BACKGROUND: The use of cyanoacrylate substances as tissue adhesives is of valuable aid in surgery, especially in cases of injuries of the intraabdominal organs, where the haemorrhage is very difficult to control. MATERIALS AND METHODS: We investigated the efficiency of isobutyl-2-cyanoacrylate as a tissue adhesive in the haemostasis and adhesion of different types of wounds in solid and hollow organs. Forty-six dogs underwent single-organ (26 dogs) and combined-organ (20 dogs) procedures; cuneiform excisions of the liver and the spleen, as well as incisions of the small intestine were carried out. The wound surfaces were coated with isobutyl-2-cyanoacrylate and approximated. RESULTS: The majority (91.3%) of the surgical operations were uncomplicated, in which a very good macroscopical and histological result was achieved. Histological examination of the surgical injuries, performed 4 months later, confirmed complete wound healing. CONCLUSION: Isobutyl-2-cyanoacrylate proved to be a very effective tissue adhesive for both solid and hollow organs, even for high risk surgical operations.

Animals↗

PubMed1986

Healing after application of tissue-adhesive material to denuded and citric acid-treated root surfaces.

This study was undertaken to evaluate the effects of a commercially available tissue adhesive upon healing of the coronal periodontium. In four squirrel monkeys, 24 teeth were extracted, and the coronal third of the roots planed free of fibers and cementum. Eight teeth were replanted without further alteration and eight were coated with tissue adhesive prior to replantation. In the remaining eight teeth, the planed surface was decalcified, coated with tissue adhesive and replanted. Histological observations were made at 1 and 7 days after replantation. In the teeth replanted after root planing alone and root planing plus tissue adhesive, epithelium migrated apically and was within the ligament space lining the denuded root at 7 days. In contrast, those teeth which were decalcified prior to application of tissue adhesive demonstrated fiber attachment to the planed root surface and little or no epithelial downgrowth.

Animals↗

PubMed1990

Resorption of fibrin tissue adhesive sealant by isolated osteoclasts in culture.

The tissue tolerance of fibrin tissue adhesive sealants has been investigated. These materials are increasingly being used to close wounds and to stabilize spongy bone transplants. An in vitro model consisting of isolated osteoclasts in primary cell culture was used. The 2 commercially available tissue adhesive sealant protein solutions differ substantially with regard to the spreading and resorption capacity of the cultivated osteoclasts.

Animals↗

PubMed1991

Tissue adhesives inhibit experimental new bone formation.

The effect of the cyanoacrylate tissue adhesive Histoacryl on new bone formation was studied in rats. Experimental heterotopic new bone formation was induced by implanting pieces of demineralized allogeneic bone matrix (DABM) in the abdominal wall of 10 growing Sprague-Dawley rats. This produces cartilage formation within and around the implants after 10 days, followed by enchondral ossification and the formation of an ossicle with remodelling bone and bone marrow after three weeks. Prior to implantation, the DABM-implants were treated with increasing amounts of the tissue adhesive n-Butyl-2-cyanoacrylate-monomer (Histoacryl). New bone formation was quantified at three weeks by assay of the ash content of the implants as a measure of net bone formation, by 45calcium uptake prior to sacrifice, and by histology. Treatment of DABM with the cyanoacrylate caused an intense inflammatory process with a foreign body reaction, and abolished bone induction and new bone formation. Tissue adhesives should be used with caution in fracture surgery since they inhibit new bone formation, cause a foreign body reaction, and may impede fracture healing.

Animals↗

PubMed2003

Which tissue adhesive for wounds?

We studied the three available tissue adhesives comparing their ease of technique, wound healing, satisfaction, merits and complications when treating childhood lacerations. Children presenting with uncomplicated wounds <2.5cm and <6h since the injury were studied. There were 17 children in each group. Results were compared for the individual tissue adhesive and the technique-contact and non-contact. The application was considered pain free in 82% of the non-contact technique and 56% for the contact technique-pain in 18 and 44%, respectively (P=0.062). Parents were satisfied in 88 and 94% for the contact and non-contact techniques, respectively (P=0.505) and the authors in 76 and 94% (P=0.119). The glove stuck to the wound in nine instances and was damaged once while breaking the container. The scab persisted in all scalp applications for 9-25 days. The adhesive effect was similar in all three. Indermil was considered to be the best among the three. Non-contact, droplet instillation (rather than contact application as was suggested for Dermabond and Histoacryl) was felt more comfortable.

Adolescent↗

PubMed2001

A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents.

BACKGROUND: Recent studies suggest that the use of octyl cyanoacrylate tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds results in a cosmetic outcome comparable to that achieved with conventional sutures. To date, no studies have looked at the use of tissue adhesive for higher-tension wounds, such as those created during cutaneous excisional procedures. OBJECTIVE: To compare the tissue adhesive octyl cyanoacrylate with standard suture for the closure of excisional wounds in children and adolescents. DESIGN: A prospective comparison with blinded assessment of cosmetic outcome. Twenty-eight wounds were closed with monofilament suture and 24 were closed with tissue adhesive. At approximately 2 months, photographs of the incisions were evaluated by 2 dermatologists blinded to the method of skin closure. SUBJECTS: Forty-two consecutive patients undergoing excisional dermatologic procedures at Children's Hospital, San Diego, Calif. These 42 patients had a total of 52 wounds that were evaluated. MAIN OUTCOME MEASURES: The cosmetic appearance of the wounds at 2 months, based on 2 validated wound scales: the Hollander Wound Evaluation Scale and a visual analog scale. RESULTS: There were no differences in early complications between the groups. The suture group scored higher on the visual analog scale (63.3 mm for suture vs 47.8 mm for tissue adhesive), and this difference was statistically significant (P =.02). The suture group also had a higher median score on the Hollander Wound Evaluation Scale, but this difference was not statistically significant (P =.09). CONCLUSION: The cosmetic outcome of cutaneous excisional surgery wounds closed with standard suturing was found to be superior to that of wounds closed with octyl cyanoacrylate.

Adolescent↗

PubMed2004

[Sutureless lamellar keratoplasty by microkeratome combined with fibrin tissue adhesive in rabbits].

OBJECTIVE: To evaluate the feasibility and safety of sutureless lamellar keratoplasty by microkeratome combined with fibrin tissue adhesive. METHODS: Twenty-four New Zealand white rabbits were divided into two groups, the donor grafts and recipient beds were made by the microkeratome, the grafts were glued over the stoma bed using the commercial product Tisseel in one group; and grafts without tissue adhesive were used as the control group. Corneal refractive power was measured by automated keratometer preoperatively and in 3 days, 2 weeks, 1 and 3 months postoperatively. Rejection and cornea transparency were observed. Confocal microscopy was used to observe corneal wound healing response and to measure the keratocyte and endothelium densities in vivo. Corneal wound healing was also evaluated using light and fluorescence microscopy. RESULTS: Ninety-two percent (11/12 eyes) of the glued grafts were retained in the Tisseel group, whereas all grafts were lost in the control group. All survived grafts were clear 1 month after surgery. However, in the control group, severe haze in the grafts occurred 2 weeks postoperatively. Confocal microscopy showed that there was a significant decrease of the keratocyte density surrounding the lenticule-host interface, and no changes occurred in the posterior keratocyte and endothelium. Histopathologic observations demonstrated the presence of a line of amorphous eosinophilic substance in the lenticule-host interface at 3 days after surgery, but the line disappeared after 1 month. Fluorescence microscopy showed no detectable regenerated stromal tissue. CONCLUSIONS: This initial study demonstrates sutureless optical lamellar keratoplasty performed by microkeratome combined with fibrin tissue adhesive is a simple and safe technique. Stromal wound healing response to this surgery is minimal. Fibrin tissue adhesive has no influence on the cornea optical property.

Animals↗

PubMed2004

A review of the literature on octylcyanoacrylate tissue adhesive.

BACKGROUND: Octylcyanoacrylate is a medical grade topical tissue adhesive that has been approved for closing surgical incisions and traumatic lacerations. We reviewed animal and human studies that evaluated its use for a variety of surgical indications and specialties. We also performed a meta-analysis of all clinical trials using octylcyanoacrylate. DATA SOURCES: Animal and human studies published in peer-reviewed articles as well as published abstracts. A search of Medline was performed using the MESH terms: tissue adhesives, cyanoacrylates, and octylcyanoacrylate. CONCLUSIONS: The current review and metanalysis demonstrate that octylcyanoacrylate can be used successfully in a wide variety of clinical and surgical settings for multiple types of wounds covering most of the surface of the human body. Prior knowledge of the limitations and technical aspects specific to wound closure with octylcyanoacrylate as well as appropriate wound selection and preparation will help ensure optimal results.

Animals↗

PubMed1997

Performance of modified cyanoacrylate composition as tissue adhesives for soft and hard tissues.

A suspected absorbable cyanoacrylate, methoxypropyl cyanoacrylate (MPC), was investigated as a component of a new modified cyanoacrylate system. Reactive modifiers based on absorbable polymeric oxalates, which act as plasticizers as well as thickening agents, were incorporated into this system. It was found that the MPC with an oxalate modifier resulted in a higher adhesive strength than isobutyl cyanoacrylate (IBC) when used to approximate soft tissue. However, the IBC was superior in hard tissue applications. This coincides with the conclusion that modulus matching of the adhesive and substrate is a key contributor to joint strength.

Animals↗

PubMed2002

Episiotomy closure comparing enbucrilate tissue adhesive with conventional sutures.

OBJECTIVES: The purpose of the study was to evaluate the use of enbucrilate tissue adhesive compared with subcuticular polyglycolic acid sutures in episiotomy wound closure. METHODS: In a prospective controlled trial, two groups were studied after undergoing an episiotomy skin wound repair using either enbucrilate tissue adhesive (n=32) or a subcuticular polyglycolic acid suture (n=30). The variables measured included pain scores during selected activities in the first 5 postnatal days, the time taken to become pain free after childbirth and the time taken to resume pain free sexual intercourse. Suitable patients were invited by the midwives to participate in the trial. If they gave consent to the trial, the gynecologist was contacted. If available, he would perform a repair using enbucrilate tissue adhesive. If he was not available, one of the midwives would perform a repair using subcuticular polyglycolic acid sutures. In this group, 90% of the women were recruited and sutured by one midwife. RESULTS: Patients treated with enbucrilate were found to have significantly less postnatal pain while walking, became pain free in a shorter period (mean=25 days vs. 18 days; P<0.01) and were able to resume pain-free intercourse sooner (mean=34 days vs. 52 days; P<0.001). CONCLUSIONS: Tissue adhesives incorporate the qualities of an ideal skin-closure material. The results demonstrate their advantage over the current standard suture-based methods of repair in the perineum. The use of adhesives merits further evaluation.

Adolescent↗

PubMed2001

[Comparative study between different conjunctival tissue adhesives].

PURPOSE: To evaluate efficacy and clinical and histopathological tolerance of a new acrylic tissue adhesive (ADAL-2) compared to sutures (Vicryl) and other available tissue adhesives (Tisuacryl) for their use in conjunctival surgery. METHODS: This was an experimental study performed in New Zealand albino rabbits with conjunctival dissection and closure by ADAL-2. Groups treated with Vicryl and Tisuacryl were compared regarding efficacy, clinical, and histological tolerance at 7, 28 and 42 days. RESULTS: Efficacy was similar in the three methods of conjunctival repositioning evaluated. Tolerance to ADAL-2 was similar to that of Vicryl suture and tolerance to ADAL-2 was superior to that to Tisuacryl. Histopathological results with ADAL-2 and Tisuacryl are similar. CONCLUSIONS: ADAL-2 tissue adhesive is an efficient and very well tolerated alternative for conjunctival closure in ophthalmic surgery.

Acrylates↗

PubMed2007

A novel synthetic tissue-adhesive hydrogel using a crosslinkable polymeric micelle.

We prepared a novel tissue-adhesive hydrogel by using a polymeric micelle consisting of an aldehyde-terminated poly(ethylene glycol)-poly(D,L-lactide) (PEG-PLA) block polymer. A Schiff base is chemically formed between the amino groups in a polyallylamine and the aldehyde groups on the surface of polymeric micelles. The hydrogel was formed in approximately 2 s when the polymeric micelle solution and polyallylamine solution are mixed in vitro. The hydrogel was rapidly formed in vivo, and it adhered to a tissue surface. Our novel tissue-adhesive hydrogel creates no risk of infectious contaminations, because it consists of only synthetic materials. Further, PEG and PLA are known to be biocompatible and noncytotoxic. The results obtained in the present study show that a hydrogel prepared by the formation of a Schiff base between aldehyde and amine groups will potentially address the need for novel tissue-adhesive materials.

Cross-Linking Reagents↗

PubMed1999

Tissue adhesives: a new method of wound repair.

Simple traumatic lacerations are one of the most common reasons for visits to the emergency department. Traditionally, wound repair has been performed using sutures. The use of tissue adhesives is an approved and popular alternative method of wound closure in several countries. Numerous published studies have found that, with appropriate use, repair of lacerations using tissue adhesives is faster, less painful, and more economical than suturing. Tissue adhesives result in fewer wound infections than suturing, and cosmetic outcomes have been comparable to or better than suturing. The newest product, 2-octylcyanoacrylate, received Food and Drug Administration approval in 1998 and is being marketed in the United States. The technique of wound repair with tissue adhesives is easily mastered and is a useful skill in the management of simple lacerations. This article provides a comprehensive review of the literature on the use of tissue adhesives and discusses them as an alternative to traditional methods of wound repair.

Adult↗

PubMed1998

Application of tissue adhesives: rapid attainment of proficiency. Stony Brook Octylcyanoacrylate Study Group.

OBJECTIVE: To evaluate the 3-month cosmetic outcome following laceration repair with a new tissue adhesive, 2-octylcyanoacrylate, as a function of physician experience with this tissue adhesive. METHODS: The authors prospectively enrolled consecutive patients >1 year of age with non-bite, non-crush-induced lacerations who presented <6 hours after injury and were treated with 2-octylcyanoacrylate. Structured closed-question data sheets were completed at the time of laceration repair and at 3-month follow-up. Long-term cosmetic appearance (>3 months) was assessed by patients using a 100-mm visual analog scale. The cosmetic outcomes were evaluated as a function of the physician application using ANOVA or chi2 tests, as appropriate. This study had 80% power to detect a 10-mm difference between the 2-octylcyanoacrylate and suture groups (alpha, 0.05). RESULTS: Seven physicians applied 2-octylcyanoacrylate to 63 patients; 61 patients received sutures. Patients were similar in the 2 groups (age, gender, race, history, and wound characteristics; p > 0.05 for all). At long-term follow-up, the cosmetic outcomes were similar in the 2-octylcyanoacrylate and suture groups according to patients (VAS 83.8 +/- 19.4 mm vs 82.5 +/- 17.6 mm; p = 0.72) and physicians (optimal score, 77% vs 80%; p = 0.67), and independent of physician experience with the 2-octylcyanoacrylate. One wound developed an infection and one wound necessitated reclosure due to dehiscence. Neither occurred with the first application. CONCLUSIONS: The 3-month cosmetic appearance of wounds treated with 2-octylcyanoacrylate is equivalent to that with sutures and does not improve as physicians become more experienced with use of this tissue adhesive. These data suggest that physicians can develop competence in application of tissue adhesives with a brief training period.

Clinical Competence↗

PubMed1986

Tissue adhesives and intestinal anastomosis.

This article presents a review of the literature concerning the employment of tissue adhesives in the production of intestinal anastomoses. The fibrin adhesive is the tissue adhesive of choice in as much as it is physiological does not possess histotoxicity or cause allergic reactions. Fibrin adhesive sealing of a conventional sutured anastomosis might improve this anastomosis as it reduced the postoperative mortality-rate significantly in a prospective study with a retrospectively matched control group comparing sealing and no sealing, but prospective, randomized trials are lacking. Finally a cyanoacrylate intestinal anastomosis has proved obsolete as in experimental trials it has proved inferior to the conventional anastomosis.

Animals↗

PubMed2001

Prospective randomized blind controlled trial comparing sutures, tape, and octylcyanoacrylate tissue adhesive for skin closure after phlebectomy.

BACKGROUND: The patient's view of the outcome after phlebectomy is mainly dependent on the cosmetic result. OBJECTIVE: To compare 5-0 monofilament sutures with tapes and tissue adhesive for wound closure after varicose vein surgery. METHODS: Seventy-nine patients undergoing varicose vein surgery were prospectively randomized in three groups (tissue adhesive, sutures, tape) for skin closure and compared. The follow-up 1 year postoperatively was done by a senior dermatologist who was blinded in the method of skin closure. RESULTS: The cosmetic outcome showed little advantage for the suture group. Taping the incisions is faster than suturing them but without significance; closure with tissue adhesive takes nearly the double of time. The closure for one incision with tissue adhesive is 40 times more expensive than with tapes and 14 times more expensive than with sutures. CONCLUSION: This study failed to demonstrate an advantage of tissue adhesive and tapes over monofilament sutures for skin closure after phlebectomy.

Adolescent↗

PubMed1999

Photocurable surgical tissue adhesive glues composed of photoreactive gelatin and poly(ethylene glycol) diacrylate.

This article presents a novel photochemically driven surgical tissue adhesive technology using photoreactive gelatins and a water-soluble difunctional macromer (poly(ethylene glycol) diacrylate: PEGDA).The gelatins were partially derivatized with photoreactive groups, such as ultraviolet light (UV)-reactive benzophenone and visible light-reactive xanthene dye (e.g., fluorescein sodium salt, eosin Y, and rose bengal). A series of the prepared photocurable tissue adhesive glues, consisting of the photoreactive gelatin, PEGDA, and a saline solution with or without ascorbic acid as a reducing agent, were viscous solutions under warming, and their effectiveness was evaluated as hemostasis- and anastomosis-aid in cardiovascular surgery. Regardless of the type of photoreactive groups, the irradiation of the photocurable tissue adhesive glues by UV or visible light within 1 min produced water-swollen gels, which had a high adhesive strength to wet collagen film. These were due to the synergistic action of photoreactive group-initiated photo-cross-linking and photograft polymerization. An increase in the irradiation time resulted in increased gel yield and reduced water swellability. A decrease in the molecular weight of PEGDA and an increase in concentration of both gelatin and PEGDA resulted in reduced water swellability and increased tensile and burst strengths of the resultant gels. In rats whose livers were injured with a trephine in laparotomy, the bleeding spots were coated with the photocurable adhesive glue and irradiated through an optical fiber. The coated solution was immediately converted to a swollen gel. The gel was tightly adhered to the liver tissue presumably by interpenetration, and concomitantly hemostasis was completed. The anastomosis treatment with the photocurable glue in the canine abdominal or thoracic aortas incised with a knife resulted in little bleeding under pulsatile flow after declamping. Histological examination showed that the glues photocured on rat liver surfaces were gradually degraded with time in vivo with infiltration of inflammatory cells and connective tissues without necrotic sign in surrounding tissue. In addition, in the laparoscopic surgery, percutaneous delivery of the glue and its in situ photogelation on rat liver surfaces were demonstrated using a specially designed fiberscope. These results indicate that the photocurable glues developed here may serve as a biodegradable tissue adhesive glue usable in cardiovascular surgery and endoscopic surgery.

Anastomosis, Surgical↗