Use Of Tissue Adhesives Research Articles

Colonic Anastomoses Reinforced With Ethyl-2-Cyanoacrylate Compared With Polydioxanone Sutures Alone in Fecal Peritonitis: An Experimental Study in Wistar Rats.

The use of tissue adhesives has been proposed as an anastomosis reinforcement; however, their efficacy has not been evaluated in a contaminated environment. The objective of this study was to determine if the use of sutures reinforced with ethyl-2-cyanoacrylate for colonic anastomoses in the presence of fecal peritonitis, in a murine animal model, decreases the frequency of dehiscence. Wistar rats were used. Fecal peritonitis was established until reaching 18 hours of evolution. Then, resection and anastomosis of the colon were performed with only polydioxanone (PDS) sutures in the control group and reinforcement with ethyl-2-cyanoacrylate in the experimental group. The dehiscence frequency and burst pressure were evaluated six days after the anastomosis was performed. We included 30 Wistar rats, all males, with a median age of five months and an average weight of 350.43 g. Anastomotic dehiscence was observed in 53.33% of the control group, in contrast with 13.33% of the experimental group (p = 0.020). There was no significant difference in burst pressure between the two groups. The use of ethyl-2-cyanoacrylate, in an experimental murine animal model, as reinforcement in colonic anastomoses in the presence of fecal peritonitis decreases the frequency of anastomotic dehiscence, although it does not increase resistance to burst pressure.

Injectable Click Fibroin Bioadhesive Derived from Spider Silk for Accelerating Wound Closure and Healing Bone Fracture.

Wound closure is a critical step in postoperative wound recovery. Substantial advancements have been made in many different means of facilitating wound closure, including the use of tissue adhesives. Compared to conventional methods, such as suturing, tissue bioadhesives better accelerate wound closure. However, several existing tissue adhesives suffer from cytotoxicity, inadequate tissue adhesive strength, and high costs. In this study, a series of bioadhesives was produced using non-swellable spider silk-derived silk fibroin protein and an outer layer of swellable polyethylene glycol and tannic acid. The gelation time of the spider silk-derived silk fibroin protein bioadhesive is less than three minutes and thus can be used during rapid surgical wound closure. By adding polyethylene glycol (PEG) 2000 and tannic acid as co-crosslinking agents to the N-Hydroxysuccinimide (NHS), and 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) reaction, the adhesive strength of the bioadhesive became 2.5 times greater than that of conventional fibrin glue adhesives. Silk fibroin bioadhesives do not show significant cytotoxicity in vitro compared with other bioadhesives. In conclusion, silk fibroin bioadhesive is promising as a new medical tool for more effective and efficient surgical wound closure, particularly in bone fractures.

Novel Application of Photo-Crosslinked Urocanic-Acid-Modified Chitosan in Corneal Wounds.

In the last few years, the use of tissue adhesives in corneal perforation has gained immense popularity in clinical practices. The present study aimed to devise a new application of urocanic-acid-modified chitosan (CS) with methylene blue (MB) as a photosensitizer for the development of a photo-crosslinked tissue adhesive. In particular, the curing time was controlled with the aid of a 650 nm red diode. Under the same irradiation condition, the mechanical properties were tuned using the photosensitizer at different concentrations. In vitro tests revealed that the gel was ductile and biocompatible. The application of the gel to a perforated cornea model stopped the leakage of aqueous humor, immediately after the gel was photo-crosslinked. The blue appearance of the gel provided high precision when applied to corneal wounds. Importantly, the crosslinked gel became transparent within 24 h, owing to the dissipation of MB from tears, and the gel spontaneously sloughed off without artificial removal. Altogether, the study reported the development of a novel photo-crosslinkable urocanic-acid-modified CS gel that exhibited significant potential to be utilized in the healing of corneal perforation.

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery.

BackgroundAbdominal panniculectomy after weight loss is a commonly performed procedure with high patient satisfaction yet continues to have a high post-operative complication profile. Several risk-reducing surgical approaches, such as preservation of Scarpa’s fascia, use of tissue adhesives, and progressive tension suture techniques have been described. However, the use of tranexamic acid (TXA) has not been previously reported in panniculectomy surgery. ObjectivesTo improve the safety and predictability of this procedure, the authors investigate whether the use of topically administered TXA during panniculectomy surgery reduces seroma, hematoma, and drain duration.MethodsConsecutive patients who underwent panniculectomy (January 2010 to January 2022) were retrospectively reviewed. Outcome measures included hematoma requiring surgical evacuation, seroma requiring percutaneous aspiration, and drain duration. Patients with thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared with a historical control group who had not received TXA.ResultsA total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months (3.7 years). The median (range) resection weight was 2.6 kg (0.15-19.96 kg). Regarding seroma and hematoma formation, the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio [OR] = 1.7, 95% CI [0.56- 4.8], P = 0.38 and OR = 2.1, 95% CI [0.4-11.8], P = 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group (18.1 [12.1] days vs 19.8 [13.9] days); however, this difference was not statistically significant, albeit clinically significant.ConclusionsAs the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although previous studies report hematoma and seroma risk reduction, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in body contouring are needed. Level of Evidence: 3

Effect of tissue adhesives in repairing perineal trauma during childbirth: A systematic review and meta-analysis.

To investigate the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth. Due to the high incidence and severe consequences of perineal trauma during childbirth, tissue adhesives are recommended as an alternative to conventional sutures to repair perineal trauma. Although many original studies have explored the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth, these studies have differed in participants, interventions and outcomes. Therefore, the effect of tissue adhesives on wound healing and pain relief in perineal trauma during childbirth is inconclusive. A systematic review and meta-analysis based on PRISMA 2020. A systematic and comprehensive literature search was conducted. Eight electronic databases, three clinical trial registers, and grey literature were searched from inception to 28th April 2021 and reference lists were also retrieved. Randomised controlled trials (RCTs) involving women with first- or second-degree perineal lacerations or women who underwent episiotomy were included. The intervention was the use of tissue adhesives alone or in combination with sutures. For the outcome indicators of perineal wound healing and pain relief, subgroup analyses based on the extent of perineal trauma and measurement time points were conducted, respectively. A total of 14 RCTs involving 2264 participants were included in this research. The results indicated that for first-degree lacerations, the incidence of wound complications was significantly higher in the tissue adhesives group. In contrast, for episiotomy, the effect of the combination of tissue adhesives and sutures was comparable to that of sutures exclusively. The pooled results revealed that tissue adhesives exerted a positive effect on relieving immediate and short-term perineal pain, but no significant difference was found in the effect of long-term pain relief. Moreover, this review also supported the effect of tissue adhesives in shortening intraoperative repair time and improving clinician-maternal satisfaction. The existing evidence illustrates that tissue adhesives effectively promote perineal wound healing and relieve immediate and short-term pain. However, for first-degree lacerations, the increased occurrence of wound complications must be prudently considered when applying tissue adhesives alone, whereas, for episiotomy, the combination of tissue adhesives and sutures may be a promising repair alternative. Future studies are encouraged to adopt long-term effect, adverse effect, and cost-effect analysis as important outcome indicators to comprehensively validate the applicability and generalisability of tissue adhesives. For first-degree perineal lacerations, we do not recommend using tissue adhesives alone to repair the wound, given the increased wound complications. While for episiotomy, the combination of tissue adhesives and sutures may be a promising alternative to the use of sutures exclusively. Additionally, the adverse effect and long-term effect of using tissue adhesives alone to repair perineal trauma should be further clarified.

Tissue adhesives for peripheral intravenous catheter securement: A prospective randomized controlled pilot trial.

In some patients securing the peripheral intravenous cannula (PIVC) with a standard adhesive dressing can be difficult because of sweat or other body fluids. The aim of our study was to evaluate the use of tissue adhesives alone as a means to secure PIVCs inserted in the emergency department. We performed a prospective interventional pilot study from November 2019 to May 2020 in a medical emergency department of an urban tertiary hospital. Patients were randomized to two groups: tissue adhesives (TA) or adhesive dressing (AD) group. After randomization we followed them until day 4. There were no significant differences between TA and AD groups in the rate of unplanned removal of PIVCs in the first 72h (57.1% vs. 45.8%, p=0.29), the rate of unplanned removal of PIVCs in the ED (0% vs. 2.1%, p=1.00), the rate of unplanned removal of PIVC in the first 24h (42.8% vs. 35.4%, p=0.52), as well as in the rate of phlebitis (7.1% vs. 14.6%, p=0.34) and the rate of any blood-stream infection (0% vs. 0%, p=1.00). We did not observe any significant differences when PIVCs inserted in the emergency department were secured with tissue adhesives alone, compared to standard adhesive dressings. We observed a high rate of unplanned removal of PIVCs, necessitating further research to determine more reliable ways of securing PIVCs.

Tissue Adhesives for Hernia Mesh Fixation: A Literature Review.

In an effort to optimize the results during inguinal hernia repair, surgeons need to consider the role of different mesh fixation techniques. The use of tissue adhesives is proposed for mesh fixation, which demonstrate similar or improved outcomes in the realm of postoperative pain, hernia recurrence, cost, and formation of a hematoma or seroma. In this review, mesh fixation using fibrin glue and cyanoacrylate glue is compared to standard suture or tack techniques. The results of this investigation warrant consideration by surgeons seeking to improve patient outcomes.

Recent Advances in Tissue Adhesives for Clinical Medicine.

Tissue adhesives have attracted more attention to the applications of non-invasive wound closure. The purpose of this review article is to summarize the recent progress of developing tissue adhesives, which may inspire researchers to develop more outstanding tissue adhesives. It begins with a brief introduction to the emerging potential use of tissue adhesives in the clinic. Next, several critical mechanisms for adhesion are discussed, including van der Waals forces, capillary forces, hydrogen bonding, static electric forces, and chemical bonds. This article further details the measurement methods of adhesion and highlights the different types of adhesive, including natural or biological, synthetic and semisynthetic, and biomimetic adhesives. Finally, this review article concludes with remarks on the challenges and future directions for design, fabrication, and application of tissue adhesives in the clinic. This review article has promising potential to provide novel creative design principles for the generation of future tissue adhesives.

Use of Cyanoacrylate N-Butyl Versus Subcuticular Suture in the Dermal Closure Following Cesarean Delivery: A Randomized Controlled Trial

Background: Currently the use of tissue adhesives for surgical wound closure has multiplied; however, its use in cesarean sections is still not well determined. The objective of this study was to compare the surgical wound healing following cesarean sections between N-butyl cyanoacrylate (Tisuacryl) and suture (Monocryl 2-0). Methods: A randomized, non-blinded controlled clinical trial was conducted from October 2017 to March 2018 at the Instituto Nacional de Perinatologia. Forty women undergoing cesarean delivery were randomly assigned to skin closure group using a random number table: 20 with N-butyl cyanoacrylate (Tisuacryl) (cases group) and 20 with Monocryl (control group). Scars were evaluated at 24 h, 1 week, 1 month and 3 months. Primary objective was to evaluate the esthetics of the scar with the scar cosmesis assessment and rating (SCAR) scale. Secondary objectives were skin closing time, the satisfaction of the patient and the satisfaction of the surgeon. Results: Demographic characteristics, including average age, body mass index and number of pregnancies, were similar in both groups. The skin closing time showed a significant decrease with a P value of 0.000 between Tisuacryl and Monocryl (54.95 ± 10.353 s in the first group vs. 407.5 ± 72.61 s) . The esthetic evolution of surgery using the SCAR scale showed a better evolution in the first visits (weekly and monthly) in the Monocryl group (2.05 ± 0.60 and 1.68 ± 0.477) vs. Tisuacryl (2.77 ± 0.685 and 2.55 ± 0.74) with a P value of 0.001 in SCAR 1 (first visit) and 0.000 in SCAR 2 (second visit). However, no significant differences were observed in the last result at 3 months (SCAR 3). Similarly, no significant differences were observed regarding the satisfaction of the surgeon or the patient. Conclusions: The results of skin healing with Tisuacryl vs. Monocryl were similar in terms of the esthetics and satisfaction of the patient or the surgeon. Therefore, the use of each one depends on surgeon/patient preferences and the availability of materials. J Clin Gynecol Obstet. 2019;8(3):85-90 doi: https://doi.org/10.14740/jcgo560

Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years

IntroductionPeripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6 h and 24 h following insertion. Material and methodsWe designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. ResultsPIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1–26.7) vs. 25.6% with standard care group (95% CI: 11.9–39.3). There was no statistically significant difference between two groups (p = 0.33).The number of patients for 24 h follow-up was not enough and the obtained data could not be included in the study. DiscussionIn this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. ConclusionEven though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.

Thromboembolic Events Secondary to Endoscopic Cyanoacrylate Injection: Can We Foresee Any Red Flags?

Background Gastric varices (GV) are associated with high morbidity and mortality in patients with portal hypertension. Endoscopic cyanoacrylate injection is the first-line recommended therapy for GV obliteration. This study aims to explore the reason behind related adverse events and better prevent its occurrence. Methods A retrospective case series study was conducted from January 1, 2013, to December 31, 2016, to identify patients who experienced severe adverse events secondary to endoscopic cyanoacrylate injection. A literature review of similar cases was performed on two medical databases, Medline and Embase. Results A total of 652 patients underwent cyanoacrylate injection at our center within the study duration. Five cases of severe adverse events related to the use of tissue adhesives were identified. Detailed clinical presentation, patient treatment, and outcomes were reviewed and analyzed. Twenty-seven similar cases were identified based on the literature review providing further insight into the study. Conclusion Although rare in incidence, systemic embolism associated with cyanoacrylate injection is often fatal or debilitating. This report may raise awareness in treatment protocol, including the necessity of preoperative angiographic studies, to avoid similar adverse events in clinical practice.

Evaluation of tensile strength of tissue adhesives made of fibrin and cyanoacrylate used as reinforcement of colon suture in “ex vivo” swine

AimTo evaluate rupture pressures of tissue adhesives of cyanoacrylate (Omnex®) and fibrin (Evicel®), used as reinforcement in colonic suture from “ex vivo” swine. MethodsSurgical procedures were performed in the Surgical Technique Laboratory. From a division in segments of 10cm of descending colon and sigmoid colon from three “ex vivo” female swine, Landrace breed, which were resected in less than six hours after the slaughter time, 30 segments were selected, 10 of each animal. They were stored in saline solution 0.9% at 36°C, being randomly allocated in three groups (Control, Evicel and Omnex), each one containing 10 segments. ResultsThe lower and higher pressure values found in the groups Control, Evicel and Omnex were 36mmHg and 41mmHg, 70mmHg and 90mmHg, 90mmHg and 120mmHg, respectively. Containing statistical significance (p-value <0.0001) concerning the 2 to 2 comparisons (Control, Evicel and Omnex) with 95% trusting rate based on the application of the Turkey Method. ConclusionOne concludes that the use of tissue adhesives in anastomoses colonic in an experimental animal model of “ex vivo” swine increased the anastomoses rupture pressures. Among the tested adhesives, cyanoacrylate presented higher rupture pressure in relation to fibrin adhesive.

Laceration Management

BackgroundTraumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care. ObjectiveInnovations in laceration management have the potential to improve patient experience with this common presentation. DiscussionStudies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit. ConclusionsRecent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.

A Randomized Controlled Trial of Tissue Adhesive Versus Sutures in the Closure of Port-Site Incisions in Laparoscopic Surgery

Cyanoacrylates have been recognized since before the 1960s as excellent tissue adhesives. They are easy to use, cost-effective, and cosmetically favorable. There are no studies from India reporting the use of tissue adhesives in laparoscopic surgery. We carried out a prospective, interventional, randomized trial of non-absorbable simple interrupted sutures versus 2-octyl cyanoacrylate in the closure of skin incisions in laparoscopic surgery with the primary objective of assessing the efficacy (approximation achieved) of both methods. The secondary objectives were to compare the operative time for closure, post-operative pain, infection and cost. There were 20 participants, 10 in either arm. Consenting patients undergoing elective laparoscopic surgery in a single surgical unit were included. Descriptive statistics were used on demographic data. Comparisons between the two methods were made on the basis of Southampton Wound Assessment Scale-SWAS grade for healing, Visual Analogue Scale-VAS scores for pain, intra-operative time, and cost. Apart from cost which was significantly higher for adhesive group, the groups did not differ significantly in terms of pain, wound approximation, and infection. Octyl cyanoacrylate is comparable to non-absorbable simple interrupted sutures in terms of closure time, post-operative pain, wound approximation and infection. The cost of using octyl cyanoacrylate is substantially higher than traditional suture material.

General principles of wound management in emergency departments

Wound management is one of the major tasks in emergency departments. The surrounding intact skin but not the wound itself should be disinfected before starting definitive wound treatment. Hair should first be removed by clipping to 1-2 mm above the skin with scissors or clippers as shaving the area with a razor damages the hair follicles and increases the risk of wound infections. Administration of local anesthetics should be performed directly through the exposed edges of the wound. After wound examination, irrigation is performed with Ringer's solution, normal saline or distilled water. The next step is débridement of contaminated and devitalized tissue. There are several wound closure techniques available, including adhesive tapes, staples, tissue adhesives and numerous forms of sutures. Management of specific wounds requires particular strategies. A bleeding control problem frequently occurs with scalp lacerations. Superficial scalp lacerations can be closed by alternative wound closure methods, for example by twisting and fixing hair and the use of tissue adhesives, i.e. hair apposition technique (HAT). For strongly bleeding lacerations of the scalp, the epicranial aponeurosis should be incorporated into the hemostasis. Aftercare varies depending on both the characteristics of the wound and those of the patient and includes adequate analgesia as well as minimizing the risk of infection. Sufficient wound aftercare starts with the treating physician informing the patient about the course of events, potential complications and providing relevant instructions.

Utility of peripheral lamelar corneal graft in PUK with corneal perforation treatment

PurposePeripheral ulcerative keratitis (PUK) is a destructive inflammation of the limbal corneal stroma with oval morphology. It is characterized by a sectorial affection with corneal thinning, usually associated with an epithelial defect, cell infiltration and progressive lysis of the stroma, which can progress to corneal perforation.We present a case of a 88 years old woman who came to our hospital with epifora and foreign body sensation in the left eye. It was observed perforated marginal corneal ulceration in inferonasal quadrant with iris incarceration. She was treated with therapeutic contact lens and topical antibiotics and was programmed for surgery. In order to maintain the corneal integrity and due to the dimensions of the perforation, we decided to employ a lamellar corneal grafting because the use of tissue adhesives or amniotic membrane coating would be insufficient. This prevents the elimination of healthy cornea and keep better the anatomy. In the same surgery the graft was covered with amniotic membrane patch securing it with biological glue and coated with therapeutic contact lens.MethodsThe lamellar corneal grafting was obtained by manually cutting one of the corneoscleral edges of a donor cornea, in which the central corneal button was drilled and used for another patient in a penetrating keratoplasty the same day of surgery.ResultsThe postoperative time coursed with no complications and showed good integration of corneal graft, through images of the anterior segment and AS‐OCT.ConclusionsLamellar corneal graft seems to be a good treatment option for maintaining the tectonic integrity in perforated patients due to peripheral ulcerative keratitis.

Tissue adhesive in free gingival graft

The aim of the present study was to review the literature regarding the utilization of 2-octyl cyanoacrylate's (Dermabond®, Ethicon US, USA) as a tissue adhesive in dentistry; also, to report its use in the stabilization and fixation of a free gingival graft, indicated to increase the width of the keratinized attached mucosa at the lower incisive region. Literature analysis revealed numerous indications for this tissue adhesive in the medical field related to maxillofacial injuries. In dentistry, clinical reports, as well as controlled clinical studies conducted in humans and in animal models, using histological analysis described positive results for the use of different cyanoacrylate-based tissue adhesives. These studies reported that the use of tissue adhesives reduced the surgical procedure time period, eliminated postoperative visits as well as the discomfort of suture removal and, in addition, did not interfere with the clinical repair process. Favorable results, like the ones described in the literature, were obtained in the present case report using Dermabond®.

Tissue adhesives for closure of surgical incisions.

Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. Only randomised controlled trials were eligible for inclusion. We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

The Clinical Use of Tissue Adhesives: A Review of the Literature

Sutures have traditionally been used in the emergency room and in the primary care setting for wound and laceration closure, but over the past several decades we have seen alternative methods of wound closure emerge. Tissue adhesives are starting to become the front-runner as the alternative to sutures. They possess many advantages and have shown great results when compared to sutures to include cost effectiveness, reduced infection rate, a reduced time requirement and improved cosmetic results. Over the past several years many other indications have started to emerge such as treatment for esophageal varices, application of skin grafts, and vascular embolization. The different chemical compositions and functions will also be reviewed. Disadvantages of tissue adhesives include lower tensile strength and a potential for systemic absorption or embolization. Overall, tissue adhesives provide an excellent means for wound closure in multiple settings and are the first choice method amongst clinicians across disciplines.

Effect of hemostatic agents on properties of gelatin–alginate soft tissue adhesives

Lacerations and traumatic wounds are considered to be among the most prevalent scenarios encountered in hospitals and emergency rooms. Reattachment of the lacerated soft tissue edges is traditionally performed using sutures. Use of tissue adhesives, i.e. substances that have the ability to firmly attach lacerated tissues back together, has raised interest as an alternative, due to several advantages. Novel tissue adhesives based on the natural polymers gelatin and alginate, and cross-linked by carbodiimide (EDC), were recently developed by our research group. In the current research, two types of hemostatic agents, tranexamic acid and kaolin, were loaded into our gelatin–alginate bioadhesive, in order to improve the adhesion abilities in the hemorrhagic environment of the wound. Their effects on the ex vivo adherence properties, physical properties, and biocompatibility were investigated. Incorporation of kaolin significantly improved the ex vivo bonding strength of the gelatin–alginate–EDC bioadhesives through a combination of three physical mechanisms and decreased the swelling ratio without affecting weight loss. In contradiction, incorporation of tranexamic acid into the bioadhesive formulation resulted in a lower ex vivo bonding strength and a higher swelling ratio and weight loss, probably due to reduced efficiency of the cross-linking reaction between the molecules of the natural polymers and the cross-linking agent EDC. The hemostatic agent-loaded bioadhesives showed good biocompatibility when tested in vitro on fibroblast cells. This research clearly shows that the incorporation of kaolin in our gelatin–alginate tissue adhesives may be a very promising novel approach for improving the bonding strength and physical properties of the tissue adhesives for use in hemorrhagic environments.