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./
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