Abstract
A case of a father who treated his child's facial laceration with the home supply of “superglue” having been previously misinformed that superglue is used to treat lacerations is presented. The differences between tissue adhesive and superglue are described and suggest that emergency staff should be careful to avoid using the term “superglue” when using tissue adhesives.
An 8‐year‐old boy was referred to the maxillofacial team. He had presented to the emergency department the day before with a laceration to the right brow, which had been glued by his father that day with his own “superglue”. The boy's father had himself attended the emergency department earlier that year with a forearm laceration, which had been glued with what he was told was superglue. As this had been effective, he had decided to use his own superglue to fix his son's laceration to save them from the bother of going to the emergency department.
On examination, the wound edges were not satisfactorily opposed, and there appeared to be glue within the wound (fig 1). It was, therefore, decided that the wound would have to be explored under a general anaesthetic.
Figure 1 The right brow showing the glued wound.
It was found that the wound extended to the periosteum, and the glue was present throughout the wound. There was evidence of active inflammation in the wound.
The wound was cleaned, irrigated and sutured in layers. The child made an uneventful recovery. The father was informed of the differences between superglue and tissue adhesives.
Discussion
Cyanoacrylate adhesives were invented by Dr Harry Coover of Kodak Laboratories when he was trying to make clear plastic suitable for gunsights.1 These were methyl‐2‐cyanoacrylate and were found to be tremendously strong. These and similar short chain cyanoacrylates experienced commercial success and became generally known as “superglues”. In the 1950s and 60s, methyl‐2‐cyanoacrylate adhesive was used to bond skin and control bleeding in open wounds. Disposable cyanoacrylate sprays were used to control haemorrhage in the Vietnam War. However, it became apparent that methyl‐2‐cyanoacrylate provokes acute and chronic tissue reaction. They also cause histotoxicity because of the exothermic nature of the polymerisation reaction of these short chain cyanoacrylates. Furthermore, they generate local high concentrations of breakdown products, which include formaldehyde and alkylcyanoacetate.2 As a result, compounds were developed that were more compatible with human tissue. These used monomers with longer alkyl chains, which owing to their slower degradation, cause less histotoxicity. These are used for wound closure and embolisation. They can also be used as dressings for burns, minor cuts, abrasions and mouth ulcers. They have been shown to provide a waterproof antimicrobial barrier and improve epithelialisation and wound healing.3
They are, therefore, quite different from superglues and much more expensive to produce.
Proper use of cyanoacrylate tissue adhesives for wound closure:
1 Wound should be in horizontal plane to prevent run‐off.
2 Wound should be clean and dry, haemostasis essential.
3 Wound edges opposed with only minimal tension.
4 Deep dermal sutures may be necessary to take tension off wound edges.
5 Adhesive applied to opposed edges to act as bridge across wound.
6 Do not get adhesive into wound.
7 Do not tell patient you are using superglue.
Footnotes
Competing interests: None.
The authors have written consent to use figure 1 for education and publication.
References
- 1.Coover H N, Joyner F B, Sheere N H. Chemistry and performance of cyanoacrylate adhesive. J Soc Plast Surg Eng 1959155–6. [Google Scholar]
- 2.Houston S, Hodge J W, Jr, Ousterhout D K.et al The effect of alphacyanoacrylates on wound healing. J Biomed Mater Res 19693281–289. [DOI] [PubMed] [Google Scholar]
- 3.Mertz P M, Davis S C, Cazzaniga et al Barrier and antimicrobial properties of 2‐octyl cyanoacrylate wound treatment films. J Cutan Med Surg 200371–6. [DOI] [PubMed] [Google Scholar]