An Overview of Surgical Glues, Sealants and Other Adhesives

What is the purpose of surgical glues or sealants?

There are many medical grade glues, sealants or adhesives available to promote a fast, cosmetically appealing, cost-effective closure for surgical wounds. Their purpose is to seal tissue to prevent air and liquid leakages, control bleeding, or approximate tissue, such as wound edges. To address the various surgical needs and properties of living tissues in the human body, the characteristics of each sealant/adhesive is carefully engineered and optimized for specific conditions and indications.

What are the ideal characteristics of surgical glues?

The ideal surgical sealant or adhesive must be safe and effective under a variety of changing or challenging conditions at the site of application such as moisture, bleeding, flexibility, and strength requirements.  It should also be easy to apply and fast drying. Surgical adhesives or glues for skin closure, may be used in conjunction with sutures and staples, or independently to hold tissue together and serve as a barrier. 

What are some examples of surgical sealants and adhesives?

-Fibrin sealant – this formulation of separately packaged human or animal fibrinogen and thrombin is used to create a fibrin clot for bleeding control (hemostat) and wound healing. The ingredients interact so that when they are applied together, they form a clot made from blood protein. It is an absorbable biological tissue adhesive which imitates the final stages of the clotting cascade, producing a clot and forming a seal along the whole length of the wound.  It degrades physiologically into granulation tissue approximately 2 weeks after the application. Fibrin sealant is the only FDA approved material for clinical use as a hemostat, sealant, and adhesive. A product example is Tisseel.

-Cyanoacrylate – Cyanoacrylate derived adhesives are synthetic glues, stronger than fibrin sealants, used for external tissue repair. They are fast acting and provide a strong bond. Cyanoacrylate derived adhesives are typically waterproof, somewhat flexible and do not require a secondary dressing. Cyanoacrylate adhesives have a potential for toxicity and tissue inflammation. However, the longer-chain derivative, 2-octyl cyanoacrylate, is less toxic, and is a more flexible formulation approved by the FDA. It dries fast, stops the bleeding, keeps out dirt and air, and typically stays in place until the wounded area is healed. It is not, however, recommended for deep or jagged wounds or for use on over areas of high mobility and flexion areas such as joints. In addition to its surgical adhesive indications, it has also been FDA approved as a barrier against common bacterial microbes. The longer chain cyanoacrylate product is often used topically to reinforce tissue closure and used for minor lacerations. An example of 2-octyl cyanoacrylate is Dermabond.

-Collagen and Thrombin – Collagen based surgical sealants are typically flowable formats made from bovine or porcine collagen, and thrombin or human plasma. These compounds assist with coagulation by delivering fibrinogen to the wound area, which helps to control bleeding. A product example is CoStasis.

-Polyethylene Glycol Polymer – These polymers are a synthetic glue hydrogel with the ability to seal fluid or air leaks, and most commonly used in cranio-spinal dura repair, lung or thoracic surgical procedures. They are photoactivated to achieve sealant properties. Polyethylene glycol polymers are bioabsorbable and stronger than fibrin sealants. A product example is DuraSeal.

– Albumin cross-linked with Glutaraldehyde – Medical adhesives consisting of bovine albumin and glutaraldehyde glues are typically reserved for use in internal surgeries such as pulmonary or vascular repair. The Glutaraldehyde bonds quickly and can withstand high pressures. A product example is Bioglue.

What are some considerations when using skin glues?

Skin glues in particular are used for small cuts or surgical wounds that have easy to approximate edges. Since most skin glues are not very flexible, they are not typically used over joints. Skin glue is waterproof, but should be kept dry for the first few days after application or as advised by a medical professional. The glue will stay in place until it peels or falls off, which is usually in about a week. 

Should I use “Super Glue” for medical care?

No. Skin glues are not to be confused with “Super Glue”.  “Super Glue” is a cyanoacrylate adhesive available at your local store, but is not a medical grade item and can be harmful to tissues. Medical grade adhesives should be used as indicated and directed by a medical professional.

To learn more about Sanara MedTech products, please visit.  https://sanaramedtech.com/surgical/

References

Jain R, Wairkar S. Recent developments and clinical applications of surgical glues: An overview. Int J Biol Macromol. 2019 Sep 15;137:95-106. doi: 10.1016/j.ijbiomac.2019.06.208. Epub 2019 Jun 27. PMID: 31255625.

Sanders L, Nagatomi J. Clinical applications of surgical adhesives and sealants. Crit Rev Biomed Eng. 2014;42(3-4):271-292. doi:10.1615/critrevbiomedeng.2014011676