Everybody and their dog recommends having superglue in the first aid kit for closing wounds in a crisis. While regular superglue can be helpful in an emergency, it's best not to use it.
Real superglue is not designed for use on the skin. It is not sterile, so there's the risk of introducing infection if the glue gets into the wound, which given it's proximity to the wound, is quite likely to happen. Furthermore, it may cause a chemical burn, which is not what you want to do when trying to help a patient. Some suggest testing it on the skin first to see if there is a reaction before using it to close a wound. The problem is, you have to wait 24 hours to see if a rash develops. By then, the risk of infection is much higher and it's too late to close the wound safely.[1] But if the medical professional has determined that the wound must be closed, there is less risk of toxicity with smaller wounds. Superglue should definitely be avoided with larger wounds.[2]
Cyanoacrylate glues formulated for use on people include Surgiseal, Liquiseal, Histacryl, and Dermabond, with the latter probably being the most widely known. They all have a pretty hefty price tag due to the amount of regulation and testing required, and they are not available to non-medical personnel. Vet-Bond is the much more reasonably priced veterinary equivalent that regular people can buy.
Before a wound is closed with glue, the following must be done:
- Stop the bleeding. Minor pressure for a short time is all that should be needed. If substantial pressure and time are needed to stop the bleeding, this is probably not the type of wound that can be safely closed with glue. Do not attempt to close a wound that is still bleeding.
- Debride and irrigate the wound. All the dirt and debris, dried blood, dead tissue, etc., must be removed. The wound should be irrigated with lots of water (it doesn't have to be sterile, just clean) using good pressure. One way is with a 60 cc syringe (no needle) or with a squeeze bottle like the ones given to new mothers after delivering their babies. Plan on using at least 100 cc of water per inch of wound per hour old.[3]
- Determine whether this wound should be closed with glue, or with anything. Glue should not be used on wounds more than 1/4 inch deep. Glue is never used in or near sensitive areas like the eyes, lips, or genitals, or on dirty or irregular wounds. Read more here. Wound closure must be done properly or there is the risk of sealing in bacteria and creating an infection. It would be better to leave the wound open rather than create an infection.
- Clean and disinfect around the wound.
- Approximate the edges of the skin by pinching them together with your fingers or forceps. You want the skin to fit together perfectly.
- Squeeze a thin line of glue above the skin that has already been pinched together. The glue goes above, not in. (Think about it: If the glue is between the skin tissues that need to knit together, those edges can't actually come together. The scar will be larger because of the void that needs to be filled where the glue once was, and healing will take longer.)
- Hold in place until dry.
- The glue will peel off as the wound heals.
Links to related posts:
Basics of Suturing
Skin Preps and Washes--When to Use Rubbing Alcohol, etc.
The Right Way to Clean Abrasions
Wound Closure Supply Options
References:
[1] Joseph Alton, The Survival Medicine Handbook, 281.
[2] Survival and Austere Medicine, 3rd Edition, 160.
[3] Ibid, 258-259.
16 september 2020
When you close a wound.....doesn't matter how....you have to make COMPLETELY SURE that you have cleaned ALL foreign matter and bacteria out of the wound. Otherwise you are simply setting the stage for a massive infection usually leading to gangrene.....and often death.
ReplyDeleteYep, as noted above.
DeleteJust, just ow. If not actually sterile, you have to remove the glue/tissue attached to the glue and then clean the bigger infected wound.
Delete