Wound Adhesive:  "Dermabond"
Gary T. Hemann, D.O., Corporate Medical Director

Several facilities have inquired about the use of adhesives in the repair of simple lacerations in the Emergency Department.  In some EDs, this therapeutic option may already be available.  At this time, it appears that simple wound closure CPT codes are applicable.

Dermabond( is a sterile liquid topical skin adhesive containing 2-octyl cyanoacrylate.  It is intended for topical application only, to hold closed easily approximated skin edges from surgical incisions, including punctures, and simple, thoroughly cleansed, trauma-induced lacerations.  The violet colored adhesive is supplied in single use applicators comprised of a crushable glass ampule with a plastic vial and applicator tip and containing 0.5 ml of liquid. Dermabond( is available from ETHICON, Inc.

Dermabond( is contraindicated in the following situations:
* any wounds with evidence of active infection;
* decubitus wounds;
* mucosal surface wounds or across mucocutaneous junctions;
* skin exposed to body fluids regularly;
* areas with dense natural hair (especially the scalp);
* known hypersensitivity to cyanoacrylate or formaldehyde.

Dermabond should not be applied to wet wounds; below the skin surface; around the eyes; in areas with prolonged or repeated exposure to moisture or friction; in high skin tension areas or across areas of increased skin tension (e.g. Joints, unless point immobilization during healing is maintained).  Wounds should be followed closely for localized infection.

Technique: 
* The wound should be thoroughly cleansed and dried.  Local anesthetic should be used, as necessary, to ensure adequate wound cleansing and debridement.  Wound edges should be manually approximated.  Subcuticular sutures may be placed, if needed.
* Dermabond( is brushed lightly over the wound edges using the applicator tip.   Polymerization occurs within a matter of seconds.  Repeated brushings are applied:  at least 3 layers of adhesive recommended.  Avoid large droplets of adhesive, as this may result in the patient experiencing a sensation of heat or discomfort. 
* Avoid excessive pressure on the applicator tip, as the wound edges may be forced apart.   Application of the adhesive within the wound itself may result in delayed wound healing and/or adverse cosmetic outcome.  The applicator should be disposed after single patient use.  The applicator can not be re-sterilized.

Wound Care Instructions to the patient should include:
* don't scratch rub, or pick at the wound or the adhesive film;
* the wound should be kept dry, though it may be briefly wet while bathing it should be blot dried immediately;
* the wound should not be exposed to excessive sunlight or tanning lamps;
* do not place tape over the wound;
* the adhesive film will slough off the skin in 5-10 days.

Available References:
J. Quinn, G. Wells, T. Sutcliffe, M. Jarmuske, J. Maw, I. Stiell, P. Johns: 
"A Randomized Trial Comparing Octylcyanoacrylate Tissue Adhesive and Sutures in the Management of Lacerations," JAMA. 1997; 277: 1527-1530.

A. Singer, J. Hollander, S. Valentine, T. Turque, C. McCuskey, J. Quinn:
"Prospective, Randomized, Controlled Trial of Tissue Adhesive (2-Octylcyanoacrylate) vs. Standard Wound Closure Techniques for Laceration Repair,"  Academic Emergency Medicine.  1998; 5: 94-99

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