I note the author of the learned paper ended with the words "The technique 
should be used with caution in areas of the body that are subject to 
tension."  Hmmm...there goes the premise of the paper then.

I think you also seem to forget the pressure/splinting effects of 
steristrips particularly over a convex surface. Widely applied pressure is 
paramount when it comes to prevention of haematoma formation, moulding of 
wound edges, and control of scar stretching. Glue provides no such niceties. 
As you say yourself, it merely "spot welds" the edges. And when the edges 
are "welded" together thus, ergo the physician feels he's done a great job. 
But he misses the welling haematoma beneath the wound flaps...

One thing I can tell you, I don't think I'll take my wound management advice 
from "scientific papers" if they're anything like Quinn's work or the like, 
including Shapiro's piggy paper.

AF

----- Original Message ----- 
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, February 13, 2007 11:49 PM
Subject: Adrian and steristrips in the red corner...

> Glue should indeed be used with caution - but at least it is stronger
> than steristrips and as strong as sutures:
> ***************
> Tensile strength of wound closure with cyanoacrylate glue.
>
>    * Shapiro AJ,
>    * Dinsmore RC,
>    * North JH Jr.
>
> General Surgery Service, Department of Surgery, Eisenhower Army Medical
> Center, Fort Gordon, Georgia 30905, USA.
>
> 2-Octyl cyanoacrylate tissue adhesive is increasingly being used for
> closure of traumatic lacerations. Data regarding the strength of
> incisions closed with 2-octyl cyanoacrylate are limited. We compared the
> strength of disruption of closure with glue with that of more
> conventional methods of wound closure. Segments of fresh porcine skin
> measuring 3.5 x 10 cm were approximated by one of four methods: 1)
> 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch
> Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a
> subcuticular fashion. Fifteen specimens were used to test each type of
> closure. The strength of closure was tested on an Instron 4502
> tensionometer. The peak force required for disruption of the closure was
> recorded and the strength of the closure was compared. Staples provided
> the strongest closure. Skin glue proved superior to Steri-Strips but
> inferior to stapled closure. The difference between skin glue and suture
> closure was not statistically significant (P = 0.12). Patterns of
> failure differed between the groups. Skin glue failed because of
> disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue
> provides a wound closure that is similar to closure with an interrupted
> subcuticular absorbable suture. This study validates the clinical use of
> skin glue for closure of surgical incisions. The technique should be
> used with caution in areas of the body that are subject to tension.
> *********
> The main reason glue fails is operator ineptitude. Although I have spent
> some time railing at the manufacturers, they continue to insist on
> teaching people to smear it across wounds. Of course it uses more which
> pleases them, but that is wrong, and wrong in the same basic way and for
> the same Victorian principles that we use interrupted sutures for dirty
> (all ours, by definition) wounds. You should use glue as a precision
> spotweld, not as sewage fills a gutter.
>
> Try and glue up a river of blood and, surely not even to your surprise -
> it doesn't hold. Hence the advice that Mum dries, you glue.
>
> Yes, steristrips seem to close a wound. Yes it all looks lovely when
> they leave the department. But look three days later! What hasn't fallen
> off is peeling back, and the skin gapes like a beached fish. I have
> several pictures to show the effect, if you wish.
>
>> *From:* Adrian Fogarty <[log in to unmask]>
>> *To:* [log in to unmask]
>> *Date:* Tue, 13 Feb 2007 23:11:47 -0000
>>
>> Glue? You've got to be kidding. Glue has the tensile strength of a
>> gnat f**ting in a hurricane. Steristrips will close a superficial
>> wound every bit as well as sutures - often better - and only ongoing
>> haemorrhage is a serious obstacle to their use, assuming the flaps
>> can be easily opposed on hairless skin.
>>
>> And since when has glue somehow become a cure for wound hypertrophy
>> or keloid formation? If it has you ought to write that one up. No
>> doubt Professor Quinn has his own journal now on "ridiculous trials
>> comparing really bad things with each other".
>>
>> Not only has glue got rather dubious tensile strength, but it really
>> does obscure the wound, and seals in any contaminant thereby
>> increasing your risk of infection. I don't mind resorting to it in
>> scalp wounds, but like to avoid it pretty much everywhere else.
>>
>> A
>>
>>
>
>
> /Rowley./