Imagine with us: You're preparing dinner, and while slicing onions you slice your finger - and it's deep enough that you need stitches. The doctor at the emergency room applies...cobwebs to your wound, and sends you home. Huh? Once upon a time that might have been the case. It wasn't until the Ancient Egyptians that wounds would have been stitched up in a manner we'd recognize - with a needle and thread. Before then, people tried everything from cobwebs to sutures fashioned from insect jaws (kind of like staples, except, you know, made from bugs), but today we're still stitching patients up the Egyptian way. Look out needle, though, you're about to meet glue. Specifically, super glue.
Super glue is a cyanoacrylate adhesive, which has been used as an instant adhesive for fixing all the things that break around your house - and it can even preserve a single snowflake - since patent number 2,768,109 for "Alcohol-Catalyzed Cyanoacrylate Adhesive Compositions/Superglue" was approved and hit store shelves in 1958. And as it turns out, it's also good in surgical settings. Instead of coming unglued in the presence of blood or water it will polymerize, creating a plug or a seal.
Super glue's surgical uses began during the Vietnam War when field medics applied the glue to open wounds in an effort to buy injured soldiers more time for treatment; in 2001 the U.S. Food and Drug Administration (FDA) approved a chemical similar to super glue, 2-octyl-cyanoacrylate (marketed as Dermabond), which sticks like cyanoacrylate but has antibacterial qualities and causes less irritation.
Since then physicians and surgeons have access to a few types of glues, some used to treat minor lacerations while others will stop bleeding in your brain. And with a 2014 discovery of a waterproof, light-activated, beach worm-inspired glue, physicians and researchers are excited about future gluing possibilities, including mending a broken heart.
5. Small Cuts and Wounds
Small cuts can be handily treated with medical-grade super glue.
Why pull out the needle and thread when you could just glue yourself back together? Medical-grade super glue 2-octyl cyanoacrylate is a liquid topical skin adhesive, developed and approved to close superficial wounds. It's best used in place of sutures that are classified on the suture sizing scale at 5-0 or less in diameter, on lacerations on the face, arms, legs and torso.
To use it, your doctor or surgeon will hold together the edges of your wound while applying a thin strip of glue over the seam; that's right, there's no anaesthetic needed. The glue dries in about 20 to 30 seconds, and because it wears away during the healing process, it's gone in about a week. (It can also be removed with a little antibiotic ointment or petroleum jelly and a little bit of peeling.)
4. Broken Breastbone
The breastbone break that's standard procedure for open-heart surgery can now be repaired with glue.
Patients undergoing open-heart surgery may find they're stitched back up with an innovative new technique: Surgeons are now repairing sternotomies - breastbones intentionally broken during the heart procedure - with glue. It not only reduces the pain post-op but also speeds up the healing process from weeks to hours.
When used along with sutures, 2-octyl-cyanoacrylate provides an additional 75 percent more strength to the wound closure than if the wound had been closed solely with sutures. Additionally, its antimicrobial qualities help fight against as many as 99 percent of unfriendly microorganisms during the critical first few days of healing [source: Ethicon].
3. Skin Grafts Sites
Staples and sutures could soon be a thing of the past when treating burn-damaged skin.
Skin grafts are an important part of burn therapy; they help keep internal tissues and organs from being exposed to unsavoury environmental factors (such as infection and additional trauma) and stimulate wound healing and reduce scarring problems (such as the development of tight or shortened scar tissue).
Traditionally, grafts are closed and kept in place with sutures, staples or clips; ask anyone in the burn unit and you'll find that all have their drawbacks, including pain and potential for additional trauma during removal.
Your body already makes a type of natural adhesive, a 'biological glue' if you will, when healing itself. The lab-made replica is fibrin sealant, and it's made from the proteins fibrinogen and thrombin from donated human plasma. Fibrin sealants capitalize on the way the body naturally builds tissues, and temporarily secure the graft in place until new connective-tissue connections regrow as the wound heals.
A fibrin-based product - marketed as Artiss - is successfully used by burn surgeons to affix and fine-tune the placement of autologous skin grafts (the type of surgery where you're your own graft donor), especially in hard-to-treat or frequently-moved areas, as well as replace the need for sutures and staples near the burn site. Additionally, the fibrin glue is associated with lower incidence of infection in burn wounds.
2. Bleeding in the Brain
Adhesive can be used to treat aneurisms, abnormal blood vessel connections, and even sinus malformation.
When surgical glue isn't being used to seal the flap of an open wound, it's also found plugging up holes, fixing leaks and filling pockets or cavities.
New-borns, because of their small sizem pose a special concern during surgery; there are sometimes limited tools for such a delicate job. Those born with arteriovenous aneurysm, the vein of Galen malformation (VGAM) described as a blood-bubble in the brain, for example, have been successfully treated with glue. Medical-grade liquid adhesives are used in an attempt to stop or slow the flow of blood to the problem area; in fact, a glue called n–butyl cyanoacrylate (n-BCA) was developed in the 1970s with aneurysm treatment in mind. It works through a strategically-located catheter. A surgeon controls an injection of the super glue into the arteries; the glue sets in 20 minutes or less, shutting the artery and stopping the blood flow.
Arteriovenous fistulas (AVF), abnormally connected blood vessels in your brain or around your spinal cord, are treated in a similar way, with endovascular embolization, depending on the classification of the fistula - basically, stopping the blood flow with glue. Super glue has also been used by University of Maryland doctors to stop a rare condition called dural sinus malformation, another condition of bleeding in the brain; in this instance, glue fills the affected cranial sinus cavity, stopping the bleeding.
1. Arteriovenous Malformations (AVM)
The availability of medical-grade glues has advanced the treatment of arteriovenous fistulas (pictured
here) and malformations.
Venous malformations are known to be tricky to remove, or were, until a pioneering medical team at Seattle Children's Hospital began using surgical super glue to treat the problem.
Arteriovenous malformations (AVM) are clusters of blood-filled veins and arteries that are tangled and have abnormal connections. They're delicate (blood vessels are described as being kind of like water balloons), and can be painful and difficult to remove. Treatment for those that grow on the head and neck involves embolization of these blood vessels; embolization is a process where a substance is injected (through a catheter placed near the lesion) into the malformed vessels in an attempt to reduce or block blood flow to the area. And in this instance, the substance is n–butyl cyanoacrylate (n-BCA), a medical-grade synthetic glue also used to treat dural arteriovenous fistulas. Glue embolization is found to make the subsequent surgical removal safer, with less blood loss and a shorter operating time.
Author's Note: Aside from trying not to glue my fingers together, or a finger to my eye, or whatever combination of awkward glue-on-skin scenarios you can image (I'm not the most graceful, you should know), I'd never really considered medical glue uses until I had to have surgical staples removed. Next time, sign me up for the bio-inspired surgical super glue - I read it's painless.
Related Articles:
More Great Links:
Article Sources:
1. ASGE Technology Committee. "Tissue adhesives: cyanoacrylate glue and fibrin sealant." American Society for Gastrointestinal Endoscopy. Vol. 78, no. 2. Pages 209-215. 2013. (Jan. 26, 2014)
2. Briggs, Bill. "Sticky fix: Surgeons using 'super glue' to mend brains." NBC News. June 11, 2013. (Jan. 26, 2014)
3. Bruns, Thomas B. and J. Mack Worthington. "Using Tissue Adhesive for Wound repair: A Practical Guide to Dermabond." American Family Physician. Vol. 1, no. 61. Pages 1383-1388. March 1, 2000. (Jan. 26, 2014)
4. Brzoska, T.; Suzuki Y.; Mogami, H.; and T. Urano. "Binding of thrombin-activated platelets to a fibrin scaffold through α(IIb)β₃ evokes phosphatidylserine exposure on their cell surface." PLOS ONE. Vol. 8, no. 2. 2013. (Jan. 26, 2014)
5. Columbia Health. "How dangerous is it to use super glue for a cut?" April 27, 2012. (Jan. 26, 2014)
6. Drug Information Online. "FDA Approves Artiss Fibrin Sealant for Use in Face-Lift Procedures." Aug. 31, 2011. (Jan. 26, 2014)
7. Enersen, Jean. "Doctors use super glue to cure problem in patient's mouth." King5 HealthLink. Oct. 15, 2013. (Jan. 26, 2014)
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10. Hart, Rachel. "Super glue helps doctors safely remove venous malformations." Seattle Children's Hospital. Feb. 21, 2013. (Jan. 26, 2014)
11. Johnson, Brian. "U of M doctors use super glue to treat rare brain condition." University of Minnesota. Sept. 11, 2013. (Jan. 26, 2014)
12. Khosh, Maurice M. "Full-Thickness Skin Grafts." Medscape. June 6, 2012. (Jan. 26, 2014)
13. Littlefield, Susan-Elizabeth. "U Of M Doctors Use Super Glue In 2 Rare Child Brain Surgeries." CBS Minnesota. Sept. 9, 2013. (Jan. 26, 2014)
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15. MIT. "Inventor of the Week: Harry Coover - Super Glue." September 2004. (Jan. 26, 2014)
16. Montemayor-Quellenberg, Marjorie. "Bio-inspired glue keeps hearts securely sealed." Brigham and Women's Hospital. Jan. 8, 2014. (Jan. 26, 2014)
17. Morrow, Thomas. "Surgeons Now Have Glue to Keep Skin Grafts in Place." Managed Care. May 2008. (Jan. 26, 2014)
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21. Sheth, Raj D. "Vein of Galen Malformation." Medscape. Dec. 4, 2013. (Jan. 26, 2014)
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23. Tieu, David D.; Ghodke, Basavaraj V.; Vo, Nghia J.; and Jonathoan A. Perkins. "Single-Stage Excision of Localized Head and Neck Venous Malformations Using Preoperative Glue Embolization." Otolarygology - Head and Neck Surgery. Vol. 148, no. 4. Jan. 28, 2013. (Jan. 26, 2014)
24. University of Calgary. "Surgeon 'glues' the breastbone together after open-heart surgery." Science Daily. Nov. 19, 2009. (Jan. 26, 2014).
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26. U.S. Food and Drug Administration (FDA). "TRUFILL® n-Butyl Cyanoacrylate (n-BCA) Liquid Embolic System." Sept. 25, 2000. (Jan. 26, 2014)
Top image: Surgical sutures are still used, but more and more injuries are being addressed with adhesive instead of stitches. Credit: ©Ingram Publishing/Thinkstock.
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