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Friday, August 31, 2012

Skin Lacerations: Stitches or Glue?

A few days ago, my four year old grandson was injured when playing with his older brother outside. His nose got in the way of a big stick that was being swung around in the air. It hit with such force that the skin on his nose was torn in two places leaving it open and flapping in the wind. His mother and I took him to the local, small town ER. The doctor there was proficient and courteous. She cleaned the wound and then glued it back together. So far, it has been healing fine with no signs of further infection. Is this the best method for skin lacerations?

According to Emergency Medicine Reports, Dr. Michael Ferguson says it can be. He reports that there are pros and cons. Actually, he calls them pearls and pitfalls. Apparently, there is the possibility that some of the glue can get on nearby skin tissues that weren't needing to be repaired and get glued stuck. If this happens to the eyelids, it's called tarsorrhaphy. This happened to a two year old boy with an eye laceration. His parents were given an antibiotic opthalmic ointment to apply regularly.

Another possible complication from the use of skin glue (cyanoacrylate skin adhesives - CSA) is called wound dehiscence. This is when the wound won't stay closed. However, this happens sometimes with stitches and staples too (apparently, about as often as with CSA). Dr. Ferguson states that the size of the wound is an important factor a doctor should consider when deciding whether or not to use CSA for wound repair.

Allergic reactions and foreign body reactions are additional complications that have been reported with the use of CSA. Allergic reactions are very rare because the glue works so fast that the body's immune system has little time to react. If this does happen, all the doctor has to do is remove the CSA and apply a little topical steroid...and of course, start stitching. As far as foreign body reactions, applying the CSA on the nearby skin surface rather than directly into the open wound will help avoid this.

So, those are the pitfalls. The pearls include better cosmetic results, especially on the face. The CSA sloughs off in about 7-10 days eliminating the need for removal in a follow up visit. It can be applied quickly and relatively painlessly and it is cost effective. If the doctor is careful not to use too much when applying the CSA, this will help reduce the likelihood of run off that causes the nearby skin tissue to get stuck together. Also, CSA works better on small (2 cm or less) wounds and areas with low tensile or stress.

So, if you should ever be coming apart at the seams...glue might be the answer.

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