Cyanoacrylate tissue adhesive in blepharoplasty

Evaluation of the efficacy of Iso amyl 2-cyanoacrylate glue in closure of extraoral surgical wound when compared with other non-absorbable suture materials- A prospective clinical study

Introduction:

Appropriate wound closure with appropriate suture material is of prime significance in surgery. Hence, we aim to assess the efficiency of ISO amyl 2-cyanoacrylate glue in closure of extraoral surgical wound when compared with other suture materials like polypropylene (prolene), nylon (ethilon) and silk (mersilk).

Materials and Methods:

We conducted a prospective clinical observational study in which 60 subjects were divided into two groups: suture group and cyanoacrylate group. They were compared for wound healing complications on days 1, 3, 7, 12, and at 1 month postoperatively with P < 0.05 as significant.

Results:

We observed that there was no statistically significant difference between the groups for the various parameters of the wound healing for the different time periods except that color acceptability and visibility were significantly superior in the cyanoacrylate group.

Conclusion:

Iso amyl 2-cyanoacrylate can be used successfully in the suture closure with excellent patient satisfaction and can be considered as an alternative to the routine suture materials.

Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice

Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion "bleph*" was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4-5 evidence). Few randomized controlled trials were performed (level 2). Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

[Traumatic peri-ocular injuries: closing wounds using 2-octyl-cyanoacrylate medical glue]

INTRODUCTION

Periocular injuries are a common reason for emergency ophthalmology consultations. Their treatment raises specific problems related to skin sensitivity and mobility as well as the ocular safety of the procedure, notably in children. The properties and method of use of synthetic adhesive Dermabond adhesive make it a useful tool for the treatment of these injuries. However, no study to date has evaluated this tool in terms of its efficacy, safety, and esthetic results.

PATIENTS AND METHOD

This prospective study included all patients presenting with linear, superficial, or deep wounds to the eyelid and/or eyebrows, consulting an emergency department over a 3-month period. It comprised the clinical and photographic follow-up of each patient. Of these patients, those receiving treatment with synthetic adhesive were selected on the basis of specific criteria.

RESULTS

The study population comprised seven patients (four of them children) presenting with six wounds to the eyelid, and two to the eyebrow. This adhesive was applied to four patients. Their mean follow-up was 22 days. No events threatening their safety were reported while using this adhesive, particularly in the children. Its immediate efficacy and comfort for the patient were deemed highly satisfactory. The esthetic outcome after 1 month could not be assessed.

CONCLUSION

Use of Dermabond synthetic adhesive is an effective, practical, and safe technique for the treatment of wounds to the eyelid and eyebrows. It was particularly appreciated in children.

The implantation of non-cell-based materials to prevent the recurrent disc herniation: an in vivo porcine model using quantitative discomanometry examination

Recurrent disc herniation is frequently observed due to leakage of nucleus pulposus through injured anulus fibrosus. There is no effective treatment to prevent recurrent disc herniation yet. In this study, we proposed to implant non-cell-based materials into the porcine disc to stimulate the growth of fibrous tissue and thereby increase the disc functional integrity. The disc herniation was simulated by anular punctures using the spinal needles. Four clinically used implantation materials, i.e., gelfoam, platinum coil, bone cement and tissue glue, were delivered into the discs via percutaneous spinal needles. Two months after the surgery, the swine were killed. The degree of disc integrity of intact, naturally healed and implanted discs, was examined by quantitative discomanometry apparatus. We found the disc injury could not recover after 2 months of healing, and the disc implantation affected the degree of disc integrity. The disc integrity of gelfoam-implanted discs was better than that of coil-, bone cement-, and glue-implanted discs. The implantation of non-cell-based material was proved to be a potentially clinically applicable method to recover the integrity of injured discs and to prevent recurrent disc herniation.

A comparison of three methods of wound closure following arthroplasty

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.

OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees.

We consider that skin staples are the skin closure of choice for both hip and knee replacements.

Clinical Evaluation of Random Skin Flaps Based on the Subdermal Plexus Secured with Sutures or Sutures and Cyanoacrylate Adhesive for Reconstructive Surgery in Dogs

OBJECTIVE

To evaluate the use of subdermal plexus skin flaps for closing defects after excision of cutaneous and subcutaneous tumors in dogs and to compare outcome of flaps secured with sutures and those secured with butyl-cyanoacrylate and intermittent sutures.

STUDY DESIGN

Clinical study.

ANIMALS

Fifteen dogs.

METHODS

After excision of cutaneous or subcutaneous tumors the skin defect was reconstructed by random flaps based on the subdermal plexus. Flap skin edges were apposed with simple interrupted 4-0 monofilament nylon sutures (group 1; 5 dogs) or nylon sutures alternated with butyl-cyanoacrylate adhesive (group 2; 10 dogs). Flaps were evaluated every 48 hours when bandages were changed, until complete healing.

RESULTS

Random flaps based on the subdermal plexus were effectively used to close wound defects; mean flap survival was 89%. Partial flap necrosis occurred in 4 dogs. Wound margins apposed with butyl-cyanoacrylate had thinner and more esthetic scars than sutured margins.

CONCLUSION

Random flaps based on the subdermal plexus proved to be versatile for covering limb wounds after excision of cutaneous or subcutaneous tumors. Mean survival rate was comparable to that reported for axial pattern flaps. Butyl-cyanoacrylate adhesive was easy to apply, allowed accurate margin apposition with good cosmetic outcome and reduced sutures needed.

CLINICAL RELEVANCE

Cyanoacrylate adhesive should be considered in lieu of suture closure to secure random skin flaps based on the subdermal plexus in dogs.

Use of isobutyl cyanoacrylate tissue adhesive to stabilize external eyelid weights in temporary treatment of facial palsies

PURPOSE

To describe a technique for stabilizing external eyelid load weights with isobutyl cyanoacrylate tissue adhesive for the temporary treatment of facial palsies.

METHODS

This was a nonrandomized, prospective study of six consecutive patients with unilateral facial paralysis treated with external eyelid load weights stabilized with isobutyl cyanoacrylate tissue adhesive instead of adhesive tape. Follow-up assessment included corneal exposure, patient comfort, amount of artificial tear usage, and complications associated with the weights.

RESULTS

Of the six patients studied, five had decreased corneal exposure, decreased artificial tear usage, and increased patient comfort with use of the weights. One patient had no improvement of symptoms. Weights were retained for a mean of 10.7 days. Two patients had difficulty with the weights; one was secondary to dermatochalasis and blepharoptosis obscuring his vision, and the other patient's weight fell off after 1 day. No weights were lost.

CONCLUSIONS

The use of isobutyl cyanoacrylate tissue adhesive is a simple, quick, and inexpensive method for placement of external eyelid weights for temporary treatment of ocular exposure associated with facial paralysis and for determining the correct weight for implantation. Furthermore, isobutyl cyanoacrylate tissue adhesive used to stabilize external eyelid weights is better tolerated and lasts longer than the previously described fixation method with adhesive tape.

Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics

OBJECTIVE

To compare the surgical efficacy and wound-healing characteristics of the tissue adhesive octyl-2-cyanoacrylate (approved by the Food and Drug Administration) with traditional suture closure in upper blepharoplasty.

METHODS

Prospective, randomized, blinded study comparing cosmetic and functional outcome and time efficiency. Twenty subjects underwent upper eyelid blepharoplasty. Each patient had a control side and an experimental side determined randomly. One eyelid incision was closed with octyl-2-cyanoacrylate (Dermabond; Ethicon Inc, Somerville, NJ) tissue glue, and the other with 6.0 suture (polypropylene or fast-absorbing gut). Comparisons were performed for the time for closure by each method, wound healing, and patient satisfaction. Macrophotographs of the wounds at 1, 2, and 4 weeks after surgery were graded by 5 observers blinded to the closure method, using a 10-point scale and a modified Hollander wound evaluation scale.

RESULTS

No statistically significant difference was found between the quality of octyl-2-cyanoacrylate closure and suture closure at 1 month. There were no differences in wound complications, duration of healing, inflammation, or final incision appearance. By 2 weeks, the sides were indistinguishable in 15 (75%) of the patients. Time for closure averaged 7 minutes with suture and 8 minutes with glue.

CONCLUSIONS

Octyl-2-cyanoacrylate glue is an excellent alternative to suture closure, producing equivalent quality of closure at all time points and no difference in appearance. This adhesive was sufficient to withstand the forces of closure in upper eyelid blepharoplasty without dehiscence in the absence of sutures.