Why you should ask your surgeon about gluing your wound

Tagged glue, wound; Comments 3 ; Posted 9 years ago by Andreas Obermair

Until recently, my practice received a significant number of phone calls from patients enquiring about their wound dressings.

When should they come off?

What if they peeled off in the shower after 4 days, a week or a fortnight?

What if the dressing became coloured?

My secretary answers every phone call, and while my staff have become experienced in answering such queries, they aren't medically trained.

My secretary will always pass on a message to my practice doctor, who will then return the call. But even as a medically trained professional, she too will find it tricky to differentiate between a normal "worn out" wound dressing, and a wound infection over the phone. Therefore my practice will often advise the patient to visit their local GP, who can confirm whether or not 

an infection is brewing underneath the dressing.

These days, I actually don’t use wound dressings any more.

Instead, I close all abdominal incisions and laparoscopic ports sites with a thin 3.0 monofilament suture, plus Dermabond, a glue to seal the wound. I simply put the glue on and wait for 30 seconds for it to polymerise.  

Guess what?

The number of phone calls about wounds has vastly diminished. No more “questionable” wound dressings means happy patients!

Instead, we now hear: “Doctor, the wound looks so neat. We can hardly see where the cut was”; or “How can you possibly take out such a large mass / uterus etc. through these tiny little openings in the skin?”

Does research support what I do?

Most research has been done through emergency centres, when kids fall and sustain a cut. This research compares wound glue versus established skin closure (sutures or staples). A handful of clinical trials (and some recent trials), have been conducted in emergency medicine (cuts to the face, limbs or skin of other regions; mostly in children), and in colorectal and cardiac surgery.

The upshot of these trials is that there is no difference in wound infection rates, and most trials report a trend towards better cosmesis (as reported by patients) after using glue closure. The key difference is also in patient satisfaction. Patients in the Dermabond glue group report significantly higher satisfaction rates.

The big disadvantage of skin glue is that it is not nearly as strong as a suture.

To overcome that weakness, the surgeon will either need to suture the skin and use glue (like I do), or use Prineo, a new combination system, which uses a tape plus glue. Prineo is as strong as using a suture plus glue, but it can be tricky in hairy areas (i.e. Pfannenstiel incisions) and it also needs to peel off.

Once again I’d be expecting phone calls from anxious patients asking when the tape can be peeled off!

Skin glue plus sutures make a watertight, strong and cosmetically appealing skin closure. I have observed that there are fewer wound infections, less scarring, and removal of sutures or stitches isn't required. Patients can shower immediately after their operation and the glue will peel off slowly over a few weeks.

Most of my surgery is planned on the abdomen / pelvis and on even surfaces. If I were dealing with crushed, contaminated or infected wounds; wounds over areas that are subject to high tension (joints) or friction (buttocks); or wounds that cross a muco-cutaneous border, then I would not use glue.

Below is a brief list of surgical wound glues that I am aware of.

• Dermabond (Johnson & Johnson Medical)
• Histoacryl (B Braun) - Available in two colours: translucent (for facial use) and blue (enabling visual control over the quantity applied).
• Indermil (Covidien/Loctite) and Liquiband (MedlogicGlobal) - Two brands of skin glue that apparently don’t sting. Hence, they are mainly used in children’s emergency centres.
• GluSeal, Glustitch (GluStitch Inc)
• Derma+flex (Chemence Medical Products Inc.)

Please feel free to leave any questions you may have in the comments section and I will be happy to answer them.