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impractical for small children, who may inadvertently remove them from the
wound.
Tissue adhesives, or skin glues, such as octyl cyanoacrylate have become
widely used for wound closure in the ED. They allow rapid and painless closure
of wounds, though if glue gets into the wound, it can cause a burning sensation or
pain. Anesthesia is unnecessary, unless painful irrigation or exploration of the
wound are anticipated. No removal is needed because adhesives slough off after 5
to 10 days. They provide an excellent cosmetic result, comparable with sutures.
One study using plastic surgeons blinded to the method of repair graded the
wounds repaired with tissue adhesives to be cosmetically equal to sutured wounds
at 2-month and 1-year follow-up visits. For scalp lacerations, hair apposition
technique (HAT) can be performed with skin glue. A few strands of hair on either
side of the scalp laceration are separated, pulled across the wound in opposite
directions (pulling together the laceration), twisted together with glue applied to
the twisted region, and repeated along the length of the wound. HAT is a painless
method of repairing scalp wounds that don’t require follow-up for stitch or staple
removal.
Tissue adhesives act to decrease wound infections because they have
antimicrobial effects against gram-positive organisms. Dehiscence rates (1% to
3%) are similar to that of sutured wounds. They are less expensive than sutures
because less equipment is required and personnel time is reduced. Studies have
noted that some patients and families of small children prefer skin adhesives to
sutures. Routine follow-up is not needed for uncomplicated wounds, and no longterm complications have been reported. Newer products such as high-viscosity
octyl cyanoacrylate tissue adhesives are less likely to migrate during repair,
making wound repair easier to accomplish.
Before application of the tissue adhesive, the wound is cleaned and hemostasis
is achieved with dry gauze and pressure. The wound’s edges are held together
manually or with forceps while the tissue adhesive is applied along the surface of
the wound. The tissue adhesive should not be applied to the inside of the wound
because it will act as a foreign body and inhibit healing. The wound edges are
held in place for about 20 to 30 additional seconds to obtain adequate bonding. If

poor alignment of wound edges is noted, the adhesive can be removed with
forceps and reapplied without further complication. The wound is then covered
carefully so adhesive portions of any bandage do not directly contact the skin
glue, to avoid pulling off the tissue adhesive with dressing changes. Avoid routine
application of antibiotic ointments by parents as these will dissolve the adhesive
and cause dehiscence.