Emergency & Acute Care Medicine

Biography

Biography: Praveen Kumar Singh

Abstract

INTRODUCTION; Effective wound closure is critical for minimizing wound complications and preventing wound dehiscence. The various wound closure techniques include  staples, traditional nylon and skin sutures, subcuticular sutures and skin adhesives.  Currently topical skin adhesives are frequently being used. Most of the adhesives used are cyanoacrylates short and long chain (butyl and isobutyl cyanoacrylates)  derivatives. Cyanoacrylates (CAC) are tissue adhesives exhibiting the objectives of achieving coaptation of surgical wound borders, and thus eliciting healing. This material is bacteriostatic and biodegradable, and exhibits suitable tensile strength. 

Cyanoacrylates glue results in cutaneous closure in less than 5 minutes. It should not be used for deep wound closure or in any patient sensitive to cyanoacrylates. Wound closure using tissue adhesives require careful attention to be given to closure of subcutaneous layer to ensure optimal approximation and tension on the edges of the wound.Cyanoacrylates glue polymerise rapidly within seconds following contact with proteinaceous surfaces to form strong and flexible bonds. This chemical property makes them extensively used in different surgical application. Prior to application of cyanoacrylates, the tissue surface should be cleaned and dried as much as possible. Protection of the surrounding tissues from accidental contact with cyanoacrylates can be done by covering them by gauze, or chloramphenicol  1% ointment. 

SURGICAL TECHNIQUE; Under nasoendotracheal intubation, skin preparation was done with povidine iodine. Skin incision for each procedure was placed in the standard location. Then reduction of fracture and plating was done. In 80% of the patients subcutaneous sutures were placed. Skin closure was done with N-butyl 2 cyanoacrylate glue. Pressure dressing was placed in the usual manner for 24hrs postoperatively. 

RESULTS; In this study, REEDA Scale was used to assess healing. Redness, edema, Ecchymosis was seen in all 10 patients, which subsided by 2nd week post operatively. None of the patients had discharge from surgical site on 1st post operative day but was noted in 2 patients 1st week post operatively. There was evidence of wound gaping in 1 patient on 1st post operative day and 2 patients at end of 1st week post operatively. Stony Brook Scar evaluation was used to evaluate post operative cosmesis in this study. No significant cosmetic impairment was found in all patients at the end of the study. Patients were highly satisfied with the excellent cosmetic results.  In this study, no adverse inflammatory reactions were encountered and it is relevant to a study conducted by Ahmed Habib et al. The Surgical glue has the characteristic of being rapidly transferred from a liquid to a solid state that occurs at room temperature without the need of catalysts, solvents or application of pressure. 

CONCLUSION; The study reflects qualitative assessment of cyanoacrylates which is simple to use & with proper application resulted in uniform and everted closure of the wound. It is cost efficient as compared to other wound closure materials. The properties of cyanoacrylate glue were appreciated clinically as it showed excellent results with respect to the closure time, post operative healing and patient comfort. 

The quantitative data as reiterated from results make us conclude that cyanoacrylate glue performed excellently and showed similar cosmetic results when scarring evaluation was done. It is noteworthy that within the limitations of this study, which includes, less sample size and short duration for evaluation, this material showed excellent results and future studies in larger sample size can overcome the above stated limitations.