N-2-butylcyanoacrylate (GluStitch™)

J.K. Rivers, MD, FRCPC


Division of Dermatology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

ABSTRACT

Cyanoacrylates are surgical adhesives that provide another option for wound closure. When compared to sutures, cyanoacrylates were found to be as effective as sutures in low tension lacerations and for the attachment of some full-thickness skin grafts. In addition, clinical practitioners have found cyanoacrylates easier to apply, time saving, and more economical. There are a number of surgical adhesives either currently available or under development. The presently available butylcyanoacrylates and octylcyanoacrylates are reviewed.

Key Words:
N-2-butylcyanoacrylate, Sutures, Octylcyanoacrylate, Butylcyanoacrylate

PHARMACOLOGY

N-2-butylcyanoacrylate is a liquid compound that polymerizes rapidly in the presence of hydroxyl ions and is used for the closure of uncomplicated skin lacerations. It is useful in emergency rooms, for pediatric physicians, and in first-aid situations where wound closure is necessary and sutures are not warranted¹. Since its discovery in 1949, several different forms of cyanoacrylates have been developed. Tissue adhesives constitute one part of an ever-expanding range of surgical adhesives. These products have been used successfully for hair transplantation⁴, splitthickness skin grafting⁵, punctal occlusion⁶, cerebrospinal fluid leak closure⁷, facial plastic surgery⁸, and corneal perforations⁹.

CLINICAL TRIALS

N-2-butylcyanoacrylate vs Sutures

When dealing with low-tension lacerations, physicians have compared skin closure using cyanoacrylates to skin closure using sutures, and found the tissue adhesive to offer some advantages with few of the disadvantages of conventional suture techniques^8,13,14,15, especially in the pediatric setting^{2,11,12,13,14}. It is less traumatic, eliminating the pain associated with the injection of local anesthetic, which may frighten an already traumatized child¹.

Overall, the application of cyanoacrylate is a painless alternative to suturing for wound repair^3,11,12, and has comparable cosmetic results¹⁴. It can be applied rapidly and is cost effective^1,14. Further, n-2-butylcyanoacrylate has been shown to reduce the risk of wound infection when compared to sutures^15,16.

Wound strength on the day after closure using cyanoacrylates is only 10–15% of sutured wounds. However, careful technique may improve the outcome³, and routine tapestrip reinforcement of the wound is recommended by the manufacturer. Ointments must be avoided, because they will weaken the glue/skin bond.

Octylcyanoacrylate vs Sutures

Another form of cyanoacrylate (i.e., octylcyanoacrylate) has also been compared with sutures. In a randomized, controlled study, physicians at the University of Michigan concluded that octylcyanoacrylate effectively closes selected lacerations, and is a relatively painless and fast method of wound repair. They estimate that this product can replace the need for suturing several million lacerations each year³.

Butylcyanoacrylate vs Octylcyanoacrylate

One recent study compared two forms of cyanoacrylate: butylcyanoacrylate and octylcyanoacrylate. Pediatric patients with facial lacerations were treated, and the investigators examined issues of cosmesis, time of application, pain perceived by the patient, and wound healing. They concluded that there was little or no difference between these two forms of cyanoacrylate². Cost difference may dictate choice.

Full-Thickness Skin Grafts

N-2-butylcyanoacrylate has been investigated as an alternative to the meticulous and time-consuming suturing required to position full-thickness skin grafts. It has been found to be useful particularly for relatively immobile areas such as the temple, forehead, and distal nose¹⁰.

Conclusion

Cyanoacrylates are becoming increasingly popular for use in wound closure in low tension lacerations and for the attachment of some full-thickness skin grafts. Of the many minor procedures carried out in ambulatory offices (e.g., excisions and biopsies in low tension areas), a method of wound closure such as this is easier, more time saving, and more economical than traditional methods.

References

1. Product monograph, GluStitch Inc. www.glustitch.com.
2. Osmond MH, Quinn JV, Sutcliffe T, Jarmuske M, Klassen TP. A randomized, clinical trial comparing butylcyanoacrylate with octylcyanoacrylate in the management of selected pediatric facial lacerations. Acad Emerg Med 6(3):171-7 (1999 March).
3. Quinn J, Wells G, Sutcliffe T, Jarmuske M, Maw J, Stiell I, Johns P. A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. JAMA 277(19):1527-30 (1997 May 21).
4. Elliott RM, Thomas RA, True RH. Advanced use of tissue adhesive in hair transplantation. J Dermatol Surg Oncol 19(9):853-8 (1993 Sep).
5. Zaki I, Scerri L, Millard L. Split skin grafting on severely damaged skin. A technique using absorbable tissue adhesive. J Dermatol Surg Oncol 20(12):827-9 (1994 Dec).
6. Patten JT. Punctal occlusion with n-butyl cyanoacrylate tissue adhesive. Ophthalmic Surg 7(2):24-6(1976 Summer).
7. Maxwell JA, Goldware SI. Use of tissue adhesive in the surgical treatment of cerebrospinal fluid leak. Experience with isobutyl 2-cyanoacrylate in 12 cases. J Neurosurg 39(3):332-6 (1973 Sep).
8. Kamer FM, Joseph JH. Histoacryl. Its use in anesthetic facial plastic surgery. Arch Otolalaryngol Head Neck Surg 115(2):193-7 (1989 Feb).
9. Kinyoun JL, Hyndiuk RA, Hull DS. Treatment of corneal perforations with cyanoacrylate. Wis Med J 73(9):S117-8 (1974 Sep).
10. Craven NM, Telfer NR. An open study of tissue adhesive in full-thickness skin grafting. J Am Acad Dermatol 40(4):607-11 (1999 Apr).
11. Barnett P, Jarman FC, Goodge J, Silk G, Aickin R. Randomised trial of histoacryl blue tissue adhesive glue versus suturing in the repair of paediatric lacerations. J Paediatr Child Health 34(6):548-50 (1998 Dec).
12. Bruns TB, Robinson BS, Smith RJ, Kile DL, Davis TP, Sullivan KM, Quinn JV. A new tissue adhesive for laceration repair in children. J Pediatr 132(6):1067-70 (1998 Jun).
13. Simon HK, McLario DJ, Bruns TB, Zempsky WT, Wood RJ, Sullivan KM. Long-term appearance of lacerations repaired using a tissue adhesive. Pediatrics 99(2):193-5 (1997 Feb).
14. Bruns TB, Simon HK, McLario DJ, Sullivan KM, Wood RJ, Anand KJ. Laceration repair using a tissue adhesive in a children’s emergency department. Pediatrics 98(4 Pt 1):673-5 (1996 Oct).
15. Giray CB, Sungur A, Atasever A, Araz K. Comparison of silk sutures and n-butyl-2-cyanoacrylate on the healing of skin wounds. A pilot study. Aust Dent J 40(1):43-5 (1995 Feb).
16. Noordzij JP, Foresman PA, Rodeheaver GT, Quinn JV, Edlich RF. Tissue adhesive wound repair revisited. J Emerg Med 12(5):645-9 (1994 Sep-Oct).
17. Blacklock D, GluStitch Inc. Personal Communication. June, 1999.

SOME SURGICAL ADHESIVES CURRENTLY AVAILABLE¹⁷