Patient Satisfaction With a Tissue Adhesive in Preauricular Fistulectomy
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A recent in-vitro study has shown that octyl-2-cyanoacrylate is effective as an antimicrobic barrier for the first 72 hours after application.7 The skin formed by octyl-2-cyanoacrylate is an effective barrier against Gram-positive and Gram-negative bacteria, including Staphylococcus epidermis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecium. It also creates a protective layer for the wound and keeps the area moist, thus favoring faster re-epithelization. Its application is simple and fast, even in the case of very large wounds.1,7,8
Cyanoacrylate adhesives have several potential benefits over sutures, including ease of use, painless application, rapid closure, cosmesis, avoidance of needle injuries and removal of the suture or staples. It reaches a maximum bond strength in 2.5 minutes, creates a barrier, and renders the wound waterproof. It allows patients to shower normally without soaking or scrubbing the surgical site; its waterproof quality is one of the merits patients found particularly favorable. For patients who undergo office-based outpatient surgery and have difficulties in performing frequent dressing changes, the lack of a dressing is also an important merit. Children undergoing skin closure with the tissue adhesive do not have to undergo stressful dressing or suture removal since wound examination can be done through the clear polymer covering. Both the children and their parents have commended these conveniences.8
It is critical to keep in mind that the main disadvantage of this tissue adhesive is its local histotoxicity. Toxic byproducts of cyanoacrylate degradation, such as cyanoacetate and formaldehyde, accumulate in the surrounding tissues. Although the tissue adhesive has a long degradation time and the slower release of toxic byproducts has the benefit of lower concentration of toxic byproducts in the surrounding tissues, the potential for a local inflammatory response exists. Additionally, the potential for an acute inflammatory response caused by the histotoxic byproducts in subcutaneous tissues limits its usage for any application below the epidermal level.1
Generally, cyanoacrylate adhesives are not recommended for patients with insulin-dependent diabetes, peripheral vascular disease, blood clotting disorders, or collagen vascular disease. Because there is no protection against keloid formation, they should not be used in patients with a history of keloid formation or a tendency to form hypertrophic scars. Patients with a known history of an allergic response or contact dermatitis to formaldehyde should not use cyanoacrylate adhesives.1
The ideal application for cyanoacrylate adhesives is on a clean, linear laceration. Certain wounds are deemed inappropriate for the use of a cyanoacrylate tissue adhesive. Decubitus ulcers, animal or human bites, or wounds with evidence of gross bacterial contamination or infection, are contraindicated for cyanoacrylate tissue adhesives. In complex lacerations or wounds with excess tension, the traditional suture method is preferred over the use of cyanoacrylate adhesives. Wounds with an unfavorable skin edge bevel are closed more precisely with vertical mattress sutures that can evert the epidermal skin edge maximally. Wounds that are on hair-bearing skin or mucosa are closed best with sutures.1
Contrary to the use of the traditional suture method, cyanoacrylate tissue adhesives tightly seal the skin and cut off the internal wound from the outside.
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