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Inadvertent tissue adhesive tarsorrhaphy of the eyelid: a review and exploratory trial of removal methods of Histoacryl
  1. Zhenghong Liu1,
  2. Yi Ting Lim2,
  3. Kwok Fai, Mark Leong3
  1. 1 Singhealth Emergency Medicine Residency Programme, Singhealth, Singapore
  2. 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  3. 3 Department of Emergency Medicine, Singapore General Hospital, Singapore
  1. Correspondence to Dr Zhenghong Liu, Emergency Medicine, Singhealth, Singapore 168751, Singapore; liuzhenghong{at}hotmail.com

Abstract

Objective The use of tissue adhesives has become a popular option for closure of wounds in the ED. There have been a growing number of reports of inadvertent tissue adhesive injuries including closure of the eyelids. We aim to identify and compare various removal methods of tissue adhesives described in the literature in an exploratory trial.

Methods A review was first conducted to establish all published methods for the removal of medical-grade tissue adhesives as well as commercial cyanoacrylates. This search was conducted on PubMed, Google Scholar and Google. All articles that reported attempts at removal of cyanoacrylate glues were included. These methods were then tested on a porcine model in an exploratory trial. Incisions were made on pigskin and closed with Histoacryl, a tissue adhesive. Three removal methods were tested—gentle rubbing with test compound after 45 or 90 s, as well as soaking in test compound. Removal methods that were successful underwent repeat testing.

Results A total of 37 sources were reviewed with 13 different removal methods suggested. Based on the information, we tested 24 different compounds. Soaking of Histoacryl-closed wounds in Polydexa ear/eye drops displayed consistent success in achieving complete separation of incision edges after 2 hours. Several other soapy substances and antibiotic ointments showed potential but were not as consistent.

Conclusion In conclusion, in our trial of removal methods of Histoacryl, soaking in Polydexa antibiotic drops consistently facilitated removal after 2 hours. This approach can be attempted after inadvertent Histoacryl injury.

  • soft tissue injury
  • wounds, research
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Footnotes

  • Contributors ZL and KFML conceived the study, designed the trial and obtained the necessary materials. ZL, YTL and KFML supervised the conduct of the trial and data collection. ZL and YTL managed the data, including quality control. ZL drafted the manuscript, and all authors contributed substantially to its revision. ZL takes responsibility for the paper as a whole.

  • Funding Free samples of Histoacryl were obtained from B. Braun for the purposes of our study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval No live animals were used. Study was conducted on pigskin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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