Adhesive sutures

Despite the universal use of sutures for wound closure, there is a need to utilize adhesives instead, because of their ease of use and the reduced risk of infection. Alkyl cyanoacrylate adhesives have been studied extensively for this use, and a significant amount of research has been performed to evaluate their interaction with living tissue [40,41 J. They have been approved for external use only, because of concerns with the fact that the polymers do not readily biodegrade and can cause inflammation around the area to which it was applied. However, these concerns are reduced for -butyl cyanoacrylate, as compared to the ethyl cyanoacrylate. There is even some evidence that their use as liquid sutures actually reduces the rate of infection around the healing wound or surgical incision [42J. 

The extent to which these new tissue adhesives and hemostats will influence surgical procedures can be seen in the following analogy. An effective carpenter cannot create a masterpiece without a saw to cut wood, nails to ensure local fixation of separate pieces of wood, and glue to cause broad surface apposition between wood surfaces. Similarly, the surgeon presently uses a scalpel to cut and divide tissues as well as a suture to create local fixation of tissues, but until... 

Quinn, J., Drzewiecki, A., Li, M., Stiell, I., Sutcliffe, T., Elmsiie, T. and Wood, W., A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann. Emerg. Med., 22, 1130-1135 (1993). 

Heis et al.19) joined superimposed skin incisions by means of the Estman-910 adhesive in experiments on rats. Having cut out a strip of glued skin of a certain size, one of its ends was immobilized, while a containement was suspended from the other end. The containement was gradually filled with water which enabled to determine the breaking load and compare it with the load that destroyed sutured skin. It is impossible, however, to estimate the strength of glueing in this case though the authors came to the conclusion that an adhesion joint was not inferior to a sutured one. 

Theoretically, sutures can be eliminated (or a minimum of sutures) and a perfect bond can be provided by adhesives within 60 s to provide sufficient bond-strength while preventing the leakage of blood from vessels or skin, whereas sutures require a period of healing before a perfect bond is achieved. The bond can be seamlessly formed to withstand a hydrostatic pressure test comparable to human blood pressure within the same curing time ( 60 s). 

Tissue adhesives are generally applied to simple lacerations where they give similar cosmetic results to suturing. It is essential that the wound edges are accurately apposed to ensure that no adhesive passes between them. There have been no reports of carcinogenicity or toxicity when they are used topically. They should not be used over joints as repetitive movement will cause the adhesive to peel off. 

While dental hygienists clean teeth, dental assistants work directly with the dentist. They prepare and sterilize instruments, remove sutures, mix adhesives, prepare fillings, make casts of teeth, and create temporary crowns. 

The needle hole was then closed with an adhesive agent and skin was put in a suture. 

General surgery Skin repair template Sutures Adhesives and sealants Silicone-collagen composite Silk, nylon, poly(glycolide-co-lactide) Cyanoacrylate, fibrin... 

Polymers undergoing Type III erosion have found applications in (a) absorbable surgical sutures, (b) surgical adhesives, (c) contraception, and (d) controlled drug release. 

Surgical Adhesives. In many procedures it is difficult to use conventional suturing techniques. Consequently, procedures whereby incisions or cut ends of arteries can be joined by means of an adhesive would represent a significant surgical advance 08). 

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