Wound closure on a budget

Cyanoacrylates (CAs), have been around since the 1940s, and have been used for wounds since Vietnam. Therefore, it is odd to consider that the FDA did not approve their use for skin until 1998. Much of this came from the reports of skin injury from the short chain CAs secondary to heat generation from the polymeration reaction, as well as lack of sterile preparation.

The problem with the FDA approved items is that they are often in single use applications, sometimes have refrigeration requirements, have significant costs, and require a physician order or prescription to carry. Would using the commercially available CAs aid in austere environments? Other authors have certainly looked at their use, and this paper basically reviews a large chunk of those papers to attempt to answer that question.

Looking in MEDLINE, The Cochrane Database, Web of Science, Cinahl, CAB Abstracts,Google Scholar, and BIOSIS, the authors used multiple search terms and reviewed all pertinent abstracts and papers. They looked at use for wound closure, as well as for burns, abrasions and blisters. A total of 82 papers were eventually referenced in the final manuscript. And in the end?

Studies showed that the tensile strength of wounds closed cyanoacrylate adhesives are dependent on the length of the alkyl group. Octyl CAs approach monocryl level of strength, but methyl and ethyl CAs are significantly weaker. Since the shorter chain CAs are the non-medical products, this is important to know if you are using it for wound closure. Reports of histotoxicity had both pro and con reports for ethyl CAs, but it most reports of injuries are minor. Applying adhesive to blisters looks to be a wash, but it may have a use yet for prevention of blisters as an artificial callous.

For burns and abrasions, the octyl CAs do not have any benefit over standard bandages or Tegaderm. All CAs appear to be bacteriotoxic, but there are no patient oriented studies. All of them are performed in petri dishes, so applicability is unknown. Certainly the products can create a barrier over any wound, but outcomes have not been measured. Non-medical CAs are certainly cheaper, with one study showing a 98.5% reduction in cost.

So you have a product that doesn’t work as well, may cause inflammation, but costs significantly less. Would you use it for wound closure? The case can be made that carrying around industrial grade adhesive is useful in all aspects of wilderness medicine, even apart from medical use. Many other things may require repair, so you likely would not be carrying anything extra in your pack. And while it isn’t the best agent, it is certainly better than nothing, and there are plenty of reports of safe use for simple injuries. No, I can’t argue that you should use it to close up your chainsaw wound, but simple lacerations are amenable to repair by non-medical adhesives.

Davis KP, Derlet RW. Cyanoacrylate glues for wilderness and remote travel medical care. Wilderness Environ Med. 2013 Mar;24(1):67-74 [PMID 23131754]

Further Reading

• Hensley J. Irrigating wounds in the wilderness. EBM Gone Wild
• Hensley J. Ants as sutures. EBM Gone Wild
• Hensley J. Wilderness wound pitfalls. EBM Gone Wild
• Hensley J. Honey, I shrunk the wound. EBM Gone Wild