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How to apply dermabond

With millions of visits to the emergency room for treatment of lacerations or pierce injuries annually, many practitioners are looking for ways to treat patients that are more time efficient, with less discomfort and good cosmetic outcome. Practitioners have the choice of using tape strips, sutures, staples and liquid adhesives. Wound closure ideally is fast, easy to do, painless, minimally scarring and inexpensive with a low infection rate and a meticulous closure.

Suturing historically has been the preferred method for closure. With meticulous approximation, strong tensile strength and the lowest dehiscence rate, suturing is superior to other methods. Nonetheless, suturing requires advanced technical skills, generally takes more time, requires the use of local anesthetic, possibly requires removal and has the greatest tissue reactivity compared with other closure methods.

Staples are fast, with low cost, low tissue reactivity and low risk of needlestick. But closure with staples is not as meticulous and can interfere with imaging studies. Surgical tapes are good for fast application, present no risk of needlestick, are inexpensive and have the lowest infection rate. But tape falls short in tensile strength, has a higher rate of dehiscence and has poor adherence over areas hair-covered. 1

Cyanoacrylate adhesives were introduced in 1949; recently, medical formulations have become available and have been approved for clinical use. Dermabond (2-octyl cyanoacrylate) is a cyanoacrylate tissue adhesive that is less toxic and four times stronger than is its cousin N-butyl-2-cyanoacrylate. Dermabond is marketed as an alternative for 5-0 or smaller sutures. It can be used to close lacerations of the face, extremities and torso. It can be used to close the surface over deep subcutaneous sutures. 2

Advantages of Tissue Adhesives

Tissue adhesives have maximum bonding strength at 150 seconds. Dermabond is considered to be equivalent in strength to healed tissue at seven days after repair. It can be applied using only a topical anesthetic, requiring no use of needles and thus allowing for faster repair time. Tissue adhesives may be better accepted by patients, especially children. Dermabond forms a water-resistant covering that is an effective barrier against bacteria; it is the first and only FDA-approved topical skin adhesive with that distinction. Dermabond sloughs off naturally, which means no return visit for suture removal. 1

Dermabond has other benefits, but it is not always the best choice to close a wound. It is not to be used on any wound with obvious signs of infection, on animal bites or on puncture wounds. It is not indicated for use over mucosal surfaces or across mucocutaneous junctions (e.g., oral cavity, lips). It should not be used over areas with high moisture levels, such as the axillae and perineum. Caution needs to be used in areas of high tension and movement, such as the skin over hands, feet and joints (unless kept dry and immobilized). Dermabond should not be used in a patient with known sensitivity to cyanoacrylates. 2

Using Dermabond

Proper use of Dermabond does take some time to learn. Practitioners need to familiarize themselves with use of the applicator and flow of the glue. Dermabond comes in two different levels of viscosity, original and high viscosity. Ethicon also makes chisel tip and precision tip applicators to facilitate application.

Wound evaluation should be performed, including time of injury, mechanism of injury and neurovascular exam. Wound preparation may require anesthesia and irrigation, debridement, exploration and scrubbing of the wound. Next, apply topical anesthetic as needed and prepare the wound with antiseptic. Approximate wound edges manually and evenly. If needed, sutures can be used to close deeper layers. Forceps, surgical tape or manufactured skin approximation devices can be used to facilitate closure.

Crush the Dermabond vial, invert it and use gentle brushing strokes over the laceration. Avoid pushing adhesive into wound—this can cause foreign body reaction. Hold the edges together for at least 30 seconds before releasing, with at least three layers applied to ensure optimal strength to the wound closure. The glue forms a seal that does not require a dressing, but one may be applied, especially with children to prevent them from picking at it.

No antibiotic ointment should be used, since it will break down the adhesive. The area can get wet but should be patted dry if it does. The patient should not bathe or swim, avoiding any excess moisture to the area. In five to 10 days, the adhesive peels off on its own.

Tips for Application

• The laceration should be positioned as close as possible to horizontal to help prevent Dermabond runoff.

• When working near the eyes, protect them with a barrier of ophthalmic petroleum jelly and a gauze pad.

• If done immediately, excess adhesive simply can be wiped away with dry gauze (you have about a 10-second “grace period”).

• If your fingers or forceps become glued to the patient, place pressure on the patient’s skin adjacent to the edge of the object and gently roll the object away.

• Use of antibiotic ointment or petroleum jelly for 30 minutes loosens the polymer for removal.

• Use a peeling motion to remove glue.

Chad J. Pechumer is a surgical PA student at the University of Alabama at Birmingham Surgical Physician Assistant Program in Birmingham, Ala. William B. Nickell is a surgeon at the Plastic Surgery Center P.C., in Birmingham, Ala., and is chief of plastic surgery service at Medical Center East in Birmingham.

1. Singer AJ, Hollander JE. Lacerations and Acute Wounds: An Evidence-Based Guide. Philadelphia, Pa: FA Davis; 2003:56-62, 83-96.

2. Bruns TB, Worthington JM. Using tissue adhesive for wound repair: a practical guide to Dermabond. Am Fam Physician. 2000;61:1383-1388.

Dermabond is a skin-adhesive liquid that is used to close small wounds and lacerations. This product is one of the most common surgical glues that can be found in the United States.It works as an alternative to stitches by sealing the surface of the skin together. This product is FDA approved for use on humans and can be purchased for single-use applications. Dermabond can last on the skin for up to 5-10 days. If the layer begins to peel off automatically, it is a sign that the wound is healing.

Why Use Dermabond

As a surgical glue, there are a few benefits to using this product.

  • Can speed up rate of healing
  • Decreases risks of infection
  • Provides a water-resistant layer to wounds
  • Less medical attention required as sutures do not need to be removed
  • Removes suture marks which lessens scar appearance

Steps to Applying Dermabond

If you are looking to use Dermabond, here are some helpful steps that you are able to follow:

  1. Clean the wound from any dirt or dried blood using antiseptic or saline solution
  2. Stop the wound from bleeding by putting pressure on the area
  3. Neatly line up the edges of the wound so that there is less scarring. This can be difficult if the cut is bigger.
  4. Start to apply the Dermabond glue starting at the edges of the wound.
  5. Apply a consistent amount of pressure on the rest of the wound to prevent it from bleeding out.
  6. Gently begin to cover each section of the wound, waiting between 2-3 minutes for the glue to settle.
  7. After you have covered the entire wound with Dermabond, you might notice some bubbles on the surface. This is normal.

How to Care For The Wound

It is important to continue treating the wound after Dermabond is applied. Here are some tips that are able to help you in caring for your wound:

Dermabond is a powerful adhesive designed to replace bandages and stitches 1. It’s designed to fall off over time, but you can remove it yourself if needed. Consult a medical professional to be sure it should be removed.

Removal

If the Dermabond was applied within the past 45 seconds or so, you can just wipe it away.

How to Remove Bandage Adhesive From Skin

Dermabond is designed to flake off on its own after about a week, so check to see whether it is.

Picking at Dermabond can help it come off. But stop if the picking is causing undue pain.

How to Use Dr. Scholl’s Freeze Away Wart Remover

If the Dermabond really needs to come off, liberally apply Vaseline or acetone and rub it in. This should loosen the bond with the skin and allow you to pull the Dermabond off.

Soak the area in warm water if the Vaseline hasn’t succeeded on its own.

If the Dermabond still doesn’t come off, consult a doctor again instead of trying anything more drastic.

If the Dermabond is stuck in the hair it might take longer to flake off. Try putting vinegar, vegetable oil or tea tree oil on the material, using cotton balls or swabs.

Warnings

Removing the Dermabond too soon can cause the wound to re-open, which could lead to scarring or infection.

If the Dermabond is too close to the eyes to safely remove, do not attempt it.

Dermabond is a powerful adhesive designed to replace bandages and stitches. It’s designed to fall off over time, but you can remove it yourself if needed. Consult a medical professional to be sure it should be removed.

If the Dermabond was applied within the past 45 seconds or so, you can just wipe it away.

Dermabond is designed to flake off on its own after about a week, so check to see whether it is.

  • Dermabond is a powerful adhesive designed to replace bandages and stitches.
  • Dermabond is designed to flake off on its own after about a week, so check to see whether it is.

Picking at Dermabond can help it come off. But stop if the picking is causing undue pain.

If the Dermabond really needs to come off, liberally apply vaseline or acetone and rub it in. This should loosen the bond with the skin and allow you to pull the Dermabond off.

Soak the area in warm water if the vaseline hasn’t succeeded on its own.

If the Dermabond still doesn’t come off, consult a doctor again instead of trying anything more drastic.

If the Dermabond is stuck in the hair it might take longer to flake off. Try putting vinegar, vegetable oil or tea tree oil on the material, using cotton balls or swabs.

WARNING

Removing the Dermabond too soon can cause the wound to reopen, which could lead to scarring or infection. If the Dermabond is too close to the eyes to safely remove, do not attempt it.

How to apply dermabond

The tissue adhesive, Dermabond, can be used as an alternative for 5-0 or smaller sutures to close wounds. It can be used to close wounds on the face, extremities and torso. The doctor may prefer Dermabond over sutures depending on their level of comfort and experience. There is better healing of the wounds on hands, legs (extremities) and torso when under the skin (subcutaneous) sutures are placed first.

Dermabond should not be used to close the wound in cases of

  • Contaminated wounds or wounds with obvious signs of infection
  • Jagged or stellate lacerations
  • Bites, punctures or crush wounds
  • Wounds on mucosal surfaces or mucocutaneous junctions (where skin and mucus membranes meet) like the inside of the mouth or lips.
  • Wounds on high moisture areas, such as the armpits and groin.
  • Wounds on hands, feet and joints (unless kept dry and immobilized in a splint to prevent premature adhesive peeling).

If using Dermabond for scalp wounds, the patient should take care to not allow excess adhesive to run through the hair. The adhesive should be kept dry in this area for at least 5 days for normal healing.

What is Dermabond?

Dermabond (2-octyl cyanoacrylate) is a cyanoacrylate tissue adhesive that forms a strong bond across opposed wound edges that allows normal healing to occur below. This topical tissue adhesive is FDA approved and marketed to replace sutures that are 5-0 or smaller in diameter for wound (incisional or laceration) repair. Besides saving time during wound repair, Dermabond provides an excellent flexible water-resistant protective coating that eliminates the need for suture removal.

Dermabond bears less toxicity and almost four times the strength of its predecessor N-butyl-2-cyanoacrylate. It also has been provided with more flexibility due to the use of special plasticizers in its formulation. It attains maximum bonding strength within just two and a half minutes. The strength of Dermabond is similar to that of healed tissue seven days after repair.

Dermabond is best suited for small and superficial lacerations. Depending on the doctor’s discretion and expertise, it may also be used on larger wounds that require subcutaneous sutures.

What are the advantages of Dermabond over sutures?

Dermabond has several advantages over sutures such a:

  • The maximum bonding strength is achieved at two and a half minutes.
  • It saves time during wound repair.
  • Its strength is equivalent to healed tissue at seven days post repair.
  • It can be applied using only a topical (over the skin) anesthetic without any need for needles.
  • It has better acceptability by patients, especially children.
  • It provides a strong water-resistant covering.
  • It eliminates the need for suture removal.
  • It is easy to use.
  • Its long-term cosmetic outcome is similar to the traditional methods of wound repair.

Cost, however, is a concern while using Dermabond instead of sutures. The cost of a vial of Dermabond is around $24 with a shelf life of 2 years. The sutures are commonly used in ambulatory care settings and cost around $5 per package. Also, Dermabond may not be suitable for closure of certain types of wounds, such as those inside the mouth, contaminated wounds and crush wounds. Sutures, however, can be used to repair these wounds as well.