Cyanoacrylic adhesives have been used as surgical adhesives for a number of years. They have become an increasingly popular method of wound closure. Recently, octylcyanoacrylate (Dermabond) has been labeled by the U.S. Food and Drug Administration for wound closure. When used appropriately, cosmetic outcome has been equivalent to that achieved with standard suture techniques. Family physicians who serve as sports team physicians are often faced with the treatment of an open wound during a sporting event. Perron and associates examined the effectiveness of surgical adhesive when used in a situation in which an athlete would immediately return to competition.
This study was conducted at two East Coast Hockey League sites in North and South Carolina. Athletes who sustained a traumatic laceration requiring repair were eligible. Exclusion criteria included lacerations of the eyelids, lips, feet and perineum. Lacerations greater than 6 cm, and those involving tendon, muscle or open-bone injuries were also excluded. Eligible wounds were anesthetized with lidocaine, irrigated with normal saline and debrided if necessary. Skin closure was accomplished using Dermabond. Wound edges were closely approximated using manual pressure from fingers or forceps. The tissue adhesive was then applied in three layers with 30 seconds elapsed between each layer. Finally, the wound was held in approximation for 60 seconds. A dry dressing was applied, and the athlete was allowed to return to competition immediately. All wounds were reexamined at the end of the competition and again in seven days to look for wound breakdown or malalignment. Wounds were rated as acceptable if there was minor malalignment or breakdown.
Thirty-two lacerations were closed in this manner. The mean size of the lacerations was 2.3 cm (range: 0.8 to 4.5 cm), and 95 percent of the wounds were on the face. Thirty-one of the 32 lacerations were deemed to have good to excellent results.
The authors conclude that Dermabond closure was capable of maintaining its skin approximation even under the duress of continued sports participation and that the cosmetic result was acceptable. While it would have been preferable for the authors to use a “blinded” reviewer in comparing wounds closed with suture versus tissue adhesive some weeks after the event, the study supports the use of this material for appropriate lacerations during a sports event.