Dermabond Provides Quick, Waterproof Incision Closure


SCOTTSDALE, ARIZ. — The tissue adhesive Dermabond has gained popularity, especially in pediatric and emergency settings, because of its short application time and improved cosmesis over older adhesives, and despite its limitations, the product has many uses, said Bari Cunningham, M.D., at a meeting sponsored by the Skin Disease Education Foundation.

Although studies have shown that Dermabond offers no significant improvement in cosmesis over traditional suturing, its benefits are reflected in substantially higher pain scores and shorter procedure time, which have made the product ideal in emergency department and pediatric settings (JAMA 1997;277:1527-30; J. Pediatr. 1998;132:1067-70).

"It's a few seconds versus the time it takes for stitches—which with children can take upward of half an hour. So the benefit is obvious," said Dr. Cunningham of Children's Hospital, San Diego, and the University of California, San Diego.

Another advantage of Dermabond over suturing is that a follow-up visit is not needed, which is convenient for patients needing to travel a long distance. In addition, wounds treated with Dermabond can withstand wetness, which is indispensable for patients who want to swim.

Dermabond's maker, Ethicon Inc., says the product seals out most infection-causing bacteria, such as certain staph, pseudomonas, and Escherichia coli. Although it's not yet certain whether that will translate into fewer postop infections, the possible antibacterial properties are intriguing, Dr. Cunningham said.

Dermabond is a relatively new tissue adhesive about three times as strong as the old cyanoacrylates, which were too weak for widespread use and tended to be brittle and prone to cracking, Dr. Cunningham said.

The product has evolved in response to dermatologists' preferences, with newer formulations being more viscous and featuring better applicator tips.

Most studies that have shown benefits to Dermabond looked at uses in incisional surgery, whereas a majority of dermatologists work more with excisional surgery. To determine the adhesive's benefits in that context, Dr. Cunningham and her colleagues conducted a study comparing suturing with tissue adhesive. In a 2-month follow-up, they found significantly better cosmesis with suturing than with the skin glue (Arch. Derm. 2001;137:1177-80).

The adhesive is ideal for incisions such as low-tension closures for cysts but is not appropriate for high-tension areas. She urged care in the eye area; there have been cases of doctors accidentally gluing a patient's eye shut. In such instances, avoid trying to pry the eye open or using water, which can make the situation worse. Instead, apply a petrolatum-based product to gently ease the eye open.

In addition to Dermabond's inappropriateness for high-tension areas, another disadvantage is that the adhesive doesn't obviate sutures altogether, because subcutaneous sutures are still required.

And then there's the price; at about $30 a vial, some question whether Dermabond is worth the cost. But, Dr. Cunningham argued, "if you factor in the cost of time taken for a postoperative visit, suture removal, and nursing, it is often more cost effective to use the Dermabond."

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

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