Easy Way of Gluing the Skin of Surgical Wounds

Rajaraman Durai; Philip CH Ng

Disclosures

Int J Clin Pract. 2009;63(7):1115-1117. 

In This Article

Abstract and Introduction

Abstract

Background: Cyanoacrylate glue is commonly used for approximation of skin after various surgical procedures.
Method: We have written this illustrated article to educate junior doctors without any practical experience in using tissue glue.
Discussion: The advantages of gluing the skin are that it is quick, saves theatre time, cheap, no stitches to remove and is waterproof. The disadvantage being it can be messy if not applied correctly.

Introduction

Cyanoacrylate glue is commonly used for approximation of skin after various surgical procedures[1] and occasionally used to embolise blood vessels[2,3] and occlude fistulas.[4] The advantages of gluing the skin are that it is quick, saves theatre time, cheap, no stitches to remove and is waterproof. There is no need for a dressing to cover the wound after gluing the skin. Apart from eyes and mucous membranes, glue may be used to close various clean wounds of the skin including the face if there is no contra-indication. However, glue application has some disadvantages, and some of them are messy, may not hold oozing wound edges and may stick to the instruments and gloves. Meticulous attention to different techniques in various situations may avoid most of the disadvantages. Gluing is common in surgery, but it is not formally taught. We have written this illustrated article to educate junior doctors without any practical experience in using tissue glue.

Various Techniques

With many years of experience in using tissue glues (Figure 1), the authors discovered their own methods of application of glue, which are safe, cosmetic and effective. The various methods are summarised below.

Figure 1.

Example of cyanoacrylate glue that is used for closure of skin wounds.

Technique 1: Use Gravity. By lifting one corner of the wound and lowering another, and with only one or two drops of glue, one can approximate small wounds (Figure 2). When a drop is applied to the highest point of the wound, the glue trickles along the wound edge and seals it. This technique (the Ng drop) may save glue.

Figure 2.

Ng's drop: lifting one corner of the wound to enable a drop of glue to trickle along the skin edges.

Technique 2: Lift the Corners to Avoid Flooding. This technique will be useful if the wound is oozing. By lifting both corners of a skin (Ng's lift) wound with skin hooks or toothed forceps, any minimal oozing is retained inside the wound and the skin wound edges are left dry. Application of glue will be effective only if the wound is dry. There is a disadvantage of this technique resulting in residual bruising.

Technique 3: Three Point Hold. When the wound is slightly bigger and everting, it may be difficult to glue without a gap. There are two options in such long big wounds. First one is to glue in small segments. Second one is our method (Durai's three point hold) (Figure 3), which is in addition to lifting the corners (Ng's lift), to use another instrument to support the middle of the wound to allow precise and easy wound edge apposition. This technique is useful in wounds which are longer than 3 cm and when the mid part gapes.

Figure 3.

Durai's three point technique of approximation of wound, also demonstrating Ng's lift to pull the wound up to keep the wound dry while applying glue.

Technique 4: Glue with Single Box Stitch. Some times for unknown reasons and constant oozing, glue will not hold the wound edges. In such cases, the wound should be dried first, then insert a box stitch (horizontal mattress) in the middle and glue it (Figure 4). This will minimise wound gaping, allowing the glue to take a good hold.

Figure 4.

Durai's finger pinch method of approximation of the small skin wound while applying glue and its outcome.

Technique 5: Finger Pinch Non-forceps Method for Superior Cosmesis. For small dry wounds, finger pinch technique will provide the best cosmetic result. With thumb and index finger, bring the edges close to each other and let the skin flatten and assume its flat contour at the same time holding the skin gently. Gluing will result in excellent outcome (The Durai's finger pinch) (Figure 5).

Figure 5.

Stitch and glue technique where a single mattress stitch is applied, particularly if the glue does not stick well and the wound edges are oozing.

Technique 6: Subcuticular Stitch and Glue. Whenever you come across a patient who performs many physical activities, you should carryout a subcuticular monocryl stitch. Instead of applying steristrips, you can simply apply glue. Then the wound will be strong as well as cosmetically pleasing.

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