A new tissue adhesive for laceration repair in children,☆☆,,★★,

Presented in part at the Pediatric Academic Societies Meeting, Washington, D.C., May 2-6, l997.
https://doi.org/10.1016/S0022-3476(98)70415-9Get rights and content

Abstract

To determine the effectiveness of a new tissue adhesive, 2-Octylcyanoacrylate (2-OCA), for laceration repair, 83 children presenting to T.C. Thompson Children's Hospital Emergency Department with lacerations meeting eligibility requirements between February and June l996 were randomized to receive 2-OCA or nonabsorbable sutures/staples. The length of time for repair was recorded. The length of time for laceration repair was decreased (2.9 minutes 2-OCA vs 5.8 minutes suture/staple; p < 0.001), the parents' assessment of the pain felt by their children in the 2-OCA group was less, and the wounds closed with tissue adhesive had slightly lower cosmesis scores. 2-OCA is an acceptable alternative to conventional methods of wound repair with comparable cosmetic outcome. (J Pediatr 1998;132:1067-70.)

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METHODS

This study was approved by the Institutional Review Committee at our facility. The investigating team included four pediatric emergency medicine attending physicians. Each physician viewed an instructional video on the use of 2-OCA and was then allowed to use sample vials on his own skin. All children presenting to T.C. Thompson Children's Hospital Emergency Department between February and June l996 were eligible to participate in the study. Patients were excluded if they were younger than 1

RESULTS

A total of 270 children out of 353 with lacerations met previous defined exclusion criteria; for 28 the parent or guardian refused study participation. Eighty-three children were enrolled with 85 wounds: the 2-OCA group (n = 42) and the suture/staple group (n = 43, one stapled patient). No wounds received steri-strips. No differences in patient or wound characteristics were seen between groups (Table). Seventy-nine lacerations occurred on the face, and six lacerations occurred on the

DISCUSSION

Tissue adhesives are based on cyanoacrylate technology first developed in the 1940s. The first adhesive, Methyl-2-cyanoacrylate, was used as a surgical adhesive by Coover et al.10 in 1959 but was found to be tissue toxic. Subsequent generations of cyanoacrylates were developed over the years (ethyl-2-cyanoacrylate, isobutyl-2-cyanoacrylate), but clinical trials revealed these adhesives to also be toxic to tissues.11 Histoacryl Blue (N-Butyl-2-Cyanoacrylate) has been available for 20 years and

References (19)

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    Cyanoacrylate tissue adhesive is widely used in EDs to repair minor lacerations [5]. This tissue adhesive is a liquid monomer that undergoes an exothermic reaction when exposed to the moisture of the skin [6]. The reaction changes the polymers and forms a resistant tissue bond, permitting normal healing of the skin [7].

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    Wound closure was faster using the adhesive, whereas the rates of wound infection, dehiscence, and optimal cosmetic results at 3 months were comparable. Similar results (using both the butyl- and octylcyanoacrylates) have been reported in a wide variety of clinical settings and specialties including general surgery, plastic surgery, neurosurgery, cardiothoracic surgery, pediatric surgery, urology, otolaryngology, ophthalmology, obstetrics, gynecology, orthopedics, and interventional cardiology [14-32]. A recent meta-analysis comparing tissue adhesives to sutures has concluded that the use of the cyanoacrylate topical adhesives is associated with similar rates of wound infection and cosmetic outcome after repairing surgical incisions [33].

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From the Department of Emergency Services, T.C. Thompson Children's Hospital, University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, Tennessee; the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and the Department of Surgery, Section of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.

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Funded in part by a grant from Closure Medical Corporation.

Closure Medical Corporation is the manufacturer of 2-Octylcyanoacrylate, and Ethicon, Inc. is the distributor. No author has any financial relationship with Ethicon, Inc. or Closure Medical Corporation.

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Reprint requests: Thomas B. Bruns, MD, Department of Emergency Services, T.C. Thompson Children's Hospital, 910 Blackford St., Chattanooga, TN 37403.

0022-3476/98/$5.00 + 0 9/22/89717

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