Sunday, January 30, 2005
Copyright © Las Vegas Review-Journal

Doctors sticking together on use of Dermabond

Gluelike product is easy to use and works well on certain types of cuts

Dermabond is an alternative to suturing in some cases. Photo by Clint Karlsen.

If only all the kings' horses and all the kings' men had had Dermabond, poor Humpty Dumpty could've been put back together again.

What's Dermabond? If you don't know, you're not alone. Physicians know all about it, because the product has been available to them for close to a decade. But it seems that not many patients who are about to undergo surgery or are cut or otherwise injured are aware that their doctors can glue them back together.

"Surprisingly, there's not as much knowledge out there in the general public as there is in the medical community, like with the other stuff where they come in and say, `I would like some Prilosec' or something, and you're saying, `OK, let me go look that up ...' As long as it's been out, I still have patients say, `You're gonna do what?' " said Dr. Wade Sears.

"I've never had anybody come to the office and ask about Super Glue for the skin," said Dr. Lee M. Reese, a general and trauma surgeon with Desert West Surgery.

But Sears, an emergency-medicine physician and medical director of the emergency room at MountainView Hospital, says he uses Dermabond "all the time."

"On any type of laceration you can use it," he said, "as long as it's not on a mucous membrane and not on a bending part. You can't use it on a knuckle or an elbow or a knee."

The advantage of Dermabond, which Reese said is the only product of its kind approved for use in the United States, is that it makes things much more simple.

"I love it because it's easier for me," Sears said. "There's no pain. You don't have to numb up the skin. You don't have to have stitches removed; it kind of wears off after four or five days, and it's all better."

Sears said the use of Dermabond is particularly effective on the face, because it may minimize scarring, particularly scarring from sutures.

"The wound has to be relatively clean, but usually head wounds are pretty clean anyway; you don't have to scrub on those a lot," he said. "If you get somebody who's been dragged behind a car, you can't do it."

Other limitations, he said, would be excessive bleeding.

"If you can't get the blood under control, the sutures help ligate some of the little bleeding vessels. If it's in hair, you can't use it. If there's a lot of tissue damage, you can't use it."

But in other situations, he said, "it works great."

"Even big lacerations -- they're using it in the operating room as well," Sears said. "Especially with bypass surgery, the big long leg lacerations. They'll use it on that."

Agreed Reese, "We use it quite a bit -- probably 50 percent of the time when we do laparoscopic surgery, maybe more."

Reese said eliminating the need to numb the skin isn't as much of an issue in surgery, when the patient is asleep. But he sees other advantages.

"From our standpoint, it allows them to take a shower pretty much as soon as they get home if they want," Reese said. "The traditional way, we usually tell our patients they can't shower for 24 hours."

"It's really good for infants and little children, where it's a struggle to pin them down to get their sutures out," he said.

"Say you have a 3-year-old who fell down and went `Boom!,' " Sears said. "One- to 2-centimeter laceration on his forehead. He doesn't understand why he gets held down" for suturing. With the use of Dermabond, he said, "he's done."

Sears said cosmetic results can sometimes be better with Dermabond.

"A lot of times with sutures, you end up with holes on either side of the laceration," he said. "The scar (from Dermabond) can be as good, if not better, as with a regular sutured repair."

But Reese said he sees similar results with Dermabond and sutures.

"They've done studies on that and there's really no difference," he said. Physicians involved in a study by the American Journal of Emergency Medicine "couldn't tell any difference between any of the patients of what material was used to close the wounds."

Reese said Dermabond is dispensed one of three ways: through a tube with a cotton-ball tip on the end, through a tube with a pin tip and with a newer, penlike device.

"All those things are to try to make it more convenient," he said, and also to achieve better control of the thinnish substance and ensure that it's applied exactly where the physician desires.

Sears and Reese noted that Dermabond is chemically similar to traditional Super Glue in that both are cyanoacrylate. It's dispensed only for professionals, although, Reese noted, "it'd be a really effective thing to have in your home. I can see it would be a home remedy to have when your kids get cut."

He cautioned not to substitute Super Glue.

"I think there's some other issues you have to know before you use that," he said.

Still, neither physician could resist a comparison -- if only a facetious one.

"Your grandparents said, `Just put some Super Glue on it,' " Sears said. "Those old wives' tales, they're usually better than you think."