Hands down, this linked article the the Journal of Urgent Care Medicine is one of the best clinical summaries of Dermabond I have ever read. Note the author does a solid melding of academics and "real world" experience. A few highlighted pearls
- The majority Dermabond failures are not due to the "glue breaking" or cohesive failure. Most of the time it is substrate failure, or the glue not bonding to the skin. Remedies include alcohol swabs around the wound to remove oil and other skin contaminants, and keeping the area as dry as possible. One superb tip was to be sure to include a boundary of 1-2 CENTIMETERS of normal skin around the laceration to allow an increased bonding area and lessen the chance of wound dehiscence. I will admit I have been using usually an area of about 5mm at most to anchor the glue. (Hint-get out a ruler and see these exact sizes- you too will be surprised!)
- Many patients bark out to the medical provider, "Well geez Doc, I could have just used the super glue I use on my exhaust pipe to pass my license tag inspection!" The article actually cites that over the counter "Super glue" polymerizes much faster than medical glue and as such, releases enough heat to cause first degree burns. So, now you get the last laugh!
- The article highlights a use I may explore, which is Dermabond on large elderly skin tears that are too frail to suture. Key here is avoiding tears that look as if they may form a large hematoma.
- Confession- I have done this too. Air movement (waving your hand) does not speed glue polymerization. The package insert for Dermabond is a 2 minute period. The article states 2.5 minutes.
- Lastly, don'f forget the #1 credo of all wound healing: The key to lessen scarring is to properly approximate the skin layers. So, you must be able to pull the wound "tight" enough to align the dermis, epidermis, and thereby prevent the glue from improperly seeping deep into the wound and slowing healing. Consider a small steristrip to approximate the area if routine skin tension does not approximate layers well. Obviously you want a small steristrip, since as mentioned above you need the skin surface area to allow full bonding.
The article is well worth your time. I guarantee you will find an item to help your practice and improve outcome.
One further tip from Dr. Chao--consider applying some LET cream to the site, which will reduce bleeding from the epinephrine vasoconstriction, and the numbing lessens the "burn". A useful tip especially for pediatric dermabonding, as the LET reassures (rightly or wrongly) the parents also.
ReplyDeleteThanks Dr. Chao, and others, please feel free to comment.