DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

CHANDRA DENTAL COLLEGE AND HOSPITAL ,

SAFEDABAD , BARABANKI-225001 (U.P) , INDIA

CERTIFICATE

This thesis proforma entitled

A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF SKIN ADHESIVE

GLUE (n BUTYL CYANOACRYLATE) VERSUS SUTURE IN CLEAN SURGICAL
INCISIONS

Have been carried out by the candidate , SURYA PRATAP SINGH, himself under our supervision.

It is further certified that the candidate has also fulfilled all the perquisites necessary for the
submission of this thesis proforma .

CHIEF SUPERVISOR

PROF.(Dr.) PRAVEEN KUMAR PANDEY

Professor & Head

Department of Oral and Maxillofacial Surgery,

Chandra Dental College and Hospital,

Safedabad, Barabanki-225001. (U.P), INDIA

CO-SUPERVISORS

PROF.(Dr.) INDRAJEET SINGH

Professor

Department of Oral and Maxillofacial Surgery,

Chandra Dental College and Hospital,

DR SUJEET SINGH DR AJAY KUMAR KUSWAHA

READER READER
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

Chandra Dental College and Hospital, Chandra Dental College and Hospital,

Safedabad, Barabanki-225001. (U.P), INDIA Safedabad, Barabanki-225001. (U.P), INDIA

DR VIKRANT SINGH

SR LECTURER
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

Chandra Dental College and Hospital,

Safedabad, Barabanki-225001. (U.P), INDIA

Name : SURYA PRATAP SINGH

Year and Month of Graduation :

University from which Graduated : DR, RAM MANOHAR LOHIA AND AVADH UNIVERSITY

Course to which admitted : MASTER OF DENTAL SURGERY (ORAL AND MAXILLOFACIAL

SURGERY)

Date of Admission to Course :

Present Status : 1 st YEAR POST GRADUATE

Department in which Subject : DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

Thesis falls : CHANDRA DENTAL COLLEGE AND HOSPITAL

SAFEDABAD, BARABANKI-225001. (U.P), INDIA

Title of thesis : “ A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF

TISSUE ADHESIVE GLUE (n-BUTYL- CYANOACRYLATE) AND
CONVENTIONAL SUTURE IN CLEAN SURGICAL INCISIONS”
brief resume of the work ANNEXURE ENCLOSED
proposed to be undertaken
for the thesis :

CHIEF- SUPERVISOR : PROF.(Dr.) PRAVEEN KUMAR PANDEY

Professor & Head

Department of Oral and Maxillofacial Surgery,
Chandra Dental College and Hospital,
Safedabad, Barabanki-225001. (U.P), INDIA

CO-SUPERVISORS PROF.(Dr.) INDRAJEET SINGH

Professor
Department of Oral and Maxillofacial Surgery,
Chandra Dental College and Hospital,
Safedabad, Barabanki-225001. (U.P), INDIA

Dr. SUJEET SINGH

Reader
Department of Oral and Maxillofacial Surgery,
Chandra Dental College and Hospital,
Safedabad, Barabanki-225001. (U.P), INDIA
Dr ajay kumar kuswaha

Reader
Department of Oral and Maxillofacial Surgery,
Chandra Dental College and Hospital,
Safedabad, Barabanki-225001. (U.P), INDIA

Dr vikrant singh

Sr lecturer
Department of Oral and Maxillofacial Surgery,
Chandra Dental College and Hospital,
Safedabad, Barabanki-225001. (U.P), INDIA
 THESIS PROFORMA

“ A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF

TISSUE ADHESIVE GLUE (n-BUTYL- CYANOACRYLATE) VERSUS
CONVENTIONAL SUTURE IN CLEAN SURGICAL INCISIONS ”

THESIS PROFORMA SUBMITTED TO DR. RAM MANOHAR LOHIA AVADH UNIVERSITY ,

FAIZABAD , (U.P) , INDIA

POST GRADUATE

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

CHANDRA DENTAL COLLEGE AND HOSPITAL ,

SAFEDABAD , BARABANKI -225001, (U.P) , INDIA

DATE OF SUBMISSION SURYA PRATAP SINGH

MDS 1 st YEAR (2022)

CERTIFICATE OF ETHICAL COMMITTEE

This Is To Certify That The Research Project Of DR. SURYA PRATAP SINGH Post Graduate Student Of

Batch (2021- 2023) In The Department Of Oral And Maxillofacial Surgery , Chandra Dental College

And Hospital, Safedabad , Barabanki Has Been Approved And Cleared By The Ethical Committee Of

Chandra Dental College And Hospital , Safedabad, Barabanki, (U.P) , India

THE TOPIC OF RESEARCH PROJECT IS AS FOLLOWS :-

A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF TISSUE

ADHESIVE GLUE (n-BUTYL- CYANOACRYLATE) VERSUS
CONVENTIONAL SUTURE IN CLEAN SURGICAL INSISIONS

Prof. (Dr.) ANAND KISHORE

PRINCIPAL
CONVENER OF ETHICAL COMMITTEE
CHANDRA DENTAL COLLEGE AND
HOSPITAL, SAFEDABAD , BARABANKI,
(U.P), INDIA
A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF TISSUE ADHESIVE
GLUE (n-BUTYL- CYANOACRYLATE) VERSUS CONVENTIONAL SUTURE IN
CLEAN SURGICAL INCISIONS

INTRODUCTION –

In The Ever-Evolving World Of Medicine , Continual Reserch And New Advances In

Technology Have Aided Our Care For Patients For Many Years. With The Recent Changes In

Healthcare Policies And Procedures, Our Search For Improved Patient Care Has Been

Directed At Finding Better Ways To Be Cost –Effective And Time Efficient, While Still

Directing Our Treatment Goals Towards Providing The Highest Quality Patient Care. One Of

The Areas That Have Continually Seen Advances In Cost And Time Efficiency Is The

Treatment And Closure Of Wounds And Lacerations.

The objective of lacertion repair or incision is to approximate the edges of the wound so

that the wound heals uneventfully. Wound closure techniques have evolved from early

developments in suturing material to advanced resources that include skin

staplers, adhesive tape and skin adhesives.(3)

Sutures (Also Known As Stitches) Have Been Around For Thousands Of Years And Are Used

To Hold Wounds Together Until The Healing Process Is Complete. The Synthetic Suture

Materials In Use Today Are The Result Of Surgical Experience From Approximately 3000

Years BCE (Before Common Era) (1). Ancient Egyptians Sutured Using Plant Fibres, Hair,

Tendons And Wool Threads, Which Have All Been Found In Mummified Remains.

A Detailed Description Of A Wound Suture And The Suture Materials Used In It Is By The

Indian Sage And Physician Sushruta, Written In 500 BC. The Greek Father Of Medicine,

Hippocrates, Described Suture Techniques, As Did The Later Roman Aulus Cornelius Celsus.
In The 10th Century, The Catgut Suture Along With The Surgery Needle Were Developed By

Abulcasis. The Catgut Suture Was Similar To That Of Strings For Violins, Guitar, And Tennis

Racquet And It Involved Harvesting Sheep Intestines.(2)

Joseph Lister endorsed the routine sterilization of all suture threads. He first attempted

sterilization with the 1860s "carbolic catgut," and chromic catgut followed two decades

later. Sterile catgut was finally achieved in 1906 with iodine treatment.

The next great leap came in the twentieth century. The chemical industry drove production

of the first synthetic thread in the early 1930s, which exploded into production of numerous

absorbable and non-absorbable synthetics. The first synthetic absorbable was based on

polyvinyl alcohol in 1931.(2)

Today, most sutures are made of synthetic polymer fibers. Silk and, rarely, gut sutures are

the only materials still in use from ancient times. In fact, gut sutures have been banned in

Europe and Japan owing to concerns regarding bovine spongiform encephalopathy. Silk

suture is still used, mainly to secure surgical drains.(2)

Sutures possesses higher tensile strength and flexibility but greater tissue friction and pose

risks of suture sinus and infection. Sutures derived from mammalian collagen undergo

enzymatic degradation whereas synthetic polymers undergo hydrolysis . Excess reaction

leads to chronic inflammation, suboptimal scarring, or suture extrusion.

To overcome these disadvantages, an alternative to the sutures, staples, clips, or skin

closure strips are the new alternatives to wound closure materials . The use of staples and

clips can rapidly close the wound edges through a simple ‘click’, especially on skin

laceration. Compared to sutures, the use of staples and clips results in a low infection rate

and a short healing time . On the contrary, they have some disadvantages, e.g. wounds

without a meticulous closure can easily lead to scarring, in addition, their high tensile
Strength Can Cause Patients To Experience More Pain During Their Removal After Wound

Healing.(4)

From The Past Three Decades , Many New Biomaterials Have Been Discovered , Tissue

Adhsesives Are One Among Them. They Were First Sythesized By Ardis In 1949 . They Are

The Derivates Of Homologus Compound Known As Alkyl Cyano Acrylates The Use Of

Cyanoacrylate Tissue Adhesives (Ctas) For The Closure Of Wounds, Both Traumatic And

Surgical, Has Grown Rapidly. The Study By Quinn Et Al, Published In This Issue Of The

Journal, Adds Support For This Method Of Wound Closure. (5)

The Skin Adhesive Most Commonly Used Today Is 2-Octyl Cyanoacrylate (Oca), A High-

Viscosity, Flexible Glue .(6) Its Use Has Been Associated With Wound Closure , Highly

Satisfactory Cosmetic Results, And Surgical Outcomes Comparable To Conventional Sutures.

Tissue Adhesives Function Both As Wound Closure Devices As Well As An Occlusive

Dressing. They Eliminate The Need For Skin Sutures, Thus Improving Scar Aesthetics While

Sealing The Wound From The External Environment. Cyanoacrylate Tissue Adhesives

Combine Cyanoacetate And Formaldehyde In A Heat Vacuum Along With A Base To Form A

Liquid Monomer. When The Monomer Comes Into Contact With Moisture On The Skin's

Surface, It Chemically Changes Into A Polymer That Binds To The Top Epithelial Layer. This

Polymer Forms A Cyanoacrylate Bridge, Binding The Two Wound Edges Together And

Allowing Normal Healing To Occur Below. The Conversion From Monomer To Polymer

Occurs Rapidly, Preventing Seepage Of The Adhesive Below The Wound Margins. (7)

The first glue developed was Methyl Cyanoacrylate, which was studied

much for its potential medical applications and was rejected because of its tissue

poison. Methyl alcohol, which is a short series of cells, contributes to this

problem. Further research has shown that by changing the type of alcohol
combined with another with a long series of cells, tissue toxins are reduced.

By increasing the size of the molecule, it was possible to increase the time taken

polymerize.(8)

N-butyl 2-cyanoacrylate is a common medical grade

adhesive, consisting of four alkyl groups in its separate series and which has been

has been shown to adhere to and have hemostatic properties with bacteriostatic properties.

Based on efficacy of advanced techniques patient may be benefited with better cosmesis,

lesser postoperative pain and less wound infection, lesser hospital stay. Hence it

is wise to study and compare adhesive glue with suture material for the

better outcome.

Surgical site infection are a significant for surgeon, despite major

improvements in antibiotics, better anesthesia, superior instruments, early

diagnosis of problem and improved techniques of postoperative vigilance.

when a surgeon sutures a clean incision, healing takes place with minimal

loss of and tissue and without significant bacterial infection with minimal

scarring and with glue the results are better in comparison with suture

material. Tissue adhesives offer barrier to microorganism to the site of

healing and therefore have a success towards reducing wound infection.

time taken for skin closure is 3 minutes with adhesive glue but with

suture material it takes about 7-10 minutes. Best cosmesis is achieved

with glue when compared with sutures. The skin suture patients need postoperative

dressing but there was minimal cost in postoperative management of wound closure with

glue. Certainly there is no risk of needle stick injury to the surgeon whilst using adhesive

rather than suture.

In case of sutured wound, multiple puncture sites are the source of

infection which is avoided in adhesive glue thereby reducing wound

infection. while applying adhesive glue for skin closure, dead space is

obliterated and complete hemostasis should be achieved for better results.

The cost-effectiveness of both glue and suture was found that although

the cost of glue is high, total effective cost including transportation

charge for follow up, loss of wages, local dressing and antibacterial

medicaments was high with suture material. The overall cost effective

was almost equal with adhesive glue and suture material.

Since adhesive glue plays very vital role in wound closure

technique, the study is performed by comparing with suture material.

AIM & OBJECTIVES :-

THE AIM OF PRESENT STUDY IS TO COMPARE THE EFFICACY OF EFFICACY OF SKIN ADHESIVE

GLUE (2-METHYL -2-CYANOPROPIONATE OR CYANOACRYLATE) VERSUS CONVENTIONAL

SKIN SUTURING BY SUTURE MATERIAL IN CLEAN SURGICAL AREAS.

REVIEW OF LITERATURE:-

HOLLY N. WILKINSON ET AL IN THEIR ARTICLE OF WOUND HEALING DESCRIBES WOUND

HEALING IS A COMPLEX, DYNAMIC PROCESS SUPPORTED BY A MYRIAD OF CELLULAR

EVENTS THAT MUST BE TIGHTLY COORDINATED TO EFFICIENTLY REPAIR DAMAGED TISSUE.

DERANGEMENT IN WOUND-LINKED CELLULAR BEHAVIOURS, AS OCCURS WITH DIABETES

AND AGEING, CAN LEAD TO HEALING IMPAIRMENT AND THE FORMATION OF CHRONIC,

NON-HEALING WOUNDS. THESE WOUNDS ARE A SIGNIFICANT SOCIOECONOMIC BURDEN

DUE TO THEIR HIGH PREVALENCE AND RECURRENCE. SO, THERE IS AN URGENT

REQUIREMENT FOR THE IMPROVED BIOLOGICAL AND CLINICAL UNDERSTANDING OF THE

MECHANISMS THAT UNDERPIN WOUND REPAIR.THE AUTHOR HAVE SUMMARIZED THAT

WITH NOVEL TISSUE, CELL AND MOLECULAR ‘OMICS' TECHNOLOGIES WILL CONSIDERABLY

ADVANCE OUR UNDERSTANDING OF WOUND PATHOLOGY. INDEED, THE FUTURE HOLDS

GREAT PROMISE FOR THE DEVELOPMENT OF INNOVATIVE NEW THERAPEUTIC STRATEGIES

FOR ADVANCED WOUND CARE.(9)

CUTANEOUS WOUND HEALING IS A DYNAMIC PROCESS THAT INVOLVES INTEGRATED

ACTION OF A NUMBER OF CELL TYPES, THE EXTRACELLUAR MATRIX AND THE SOLUBLE

MEDIATORS CALLED CYTOKINES. IN RECENT YEARS SIGNIFICANT IMPROVEMENTS HAVE

BEEN MADE IN THE FIELD UNDERSTANDING THE INTERACTION OF CELL AND CELL MATRIX
IN THE CUTANEOUS WOUND HEALING. CUTANEOUS WOUND HEALING IS VERY IMPORTANT

IN THE MOUTH AS WELL MAXILLOFACIAL SURGEONS BECAUSE UNSATISFACTORY HEALING

FOLLOWS CLOSURE OF FACIAL LACERATIONS AND ELECTIVE INCISION MAY CAUSE SEVERE

DEFORMITY AND CHRONIC PSYCHOLOGICAL PROBLEMS. FOR EXAMPLE, A DEFROMITY HAS

BEEN SHOWN TO TRIGGER AND EXTEND THE DURATION OF POST-TRAUMATIC STRESS ON

VICTIMS OF TRAUMA. THIS ARTICLE BY D.W. THOMAS ET AL DESCRIBES THE CURRENT

UNDERSTANDING OF PROCESSES THAT THEY OCCUR AFTER SOFT TISSUE INJURY AND

ASSOCIATE THIS WITH RECOGNITION ONCE REDUCING MORBIDITY IN PATIENTS

RECOVERING FROM MAXILLOFACIAL TRAUMA. IN FUTURE, BIOMODULATION OF THE

WOUND SITE THROUGH THE USE OF EXOGENOUS CYTOKINES AND GROWTH FACTORS CAN

PROVIDE GREAT ENERGY REDUCTION OF SCARS FOLLOWS A WOUND ON THE FACE. (10)

BRENT KINCAID ET AL. THEIR STUDY ON TISSUE DAMAGE AND HEALING CONFIRMED THAT

EXTENSIVE LITERATURE ON WOUND HEALING FOCUSES PRIMARILY ON

SKIN WOUNDS . WHETHER IT'S A SURGICAL INCISION, A SIMPLE TRAUMATIC LACERATION,

OR A COMPLEX BLAST, ALL WOUNDS SHARE THE SAME BASIC REPAIR PATTERN . A STRIKING

FEATURE IS THE DURATION OF THE TIME SPENT IN VARIOUS STAGES OF WOUND HEALING.

FOREIGN BODY , CONTAMINATION, FRAGMENTATION, DEFECT SIZE, ASSOCIATED THERMAL

DAMAGE, AND DEGREE OF FUNCTIONAL IMPAIRMENT CAN DECISIVELY CHANGE THE

BODY'S BASIC REPAIR PROCESS. THIS ARTICLE USES SKIN AS A MODEL TO DEFINE ACUTE

WOUND HEALING, AND FOCUSES ON THE DIFFERENT TYPES OF WOUND PATTERNS

EXPECTED IN THE MASS CASUALTY SCENARIO. THIS ARTICLE ALSO INCLUDES AN

EXPLANATION OF THE PRINCIPLES OF ASSISTING WOUND HEALING AND SURGICAL

RECONSTRUCTION. THE AUTHORS CONCLUDE THAT TIME FRAME, TISSUE GROWTH, AND
CELL TYPE ARE IMPORTANT FACTORS IN THE HEALING PROCESS THAT CAN AFFECT

TREATMENT. VARIOUS INJURY PATTERNS, INCLUDING TYPES OF LACERATIONS, BLUNT AND

PENETRATING TRAUMA, BLAST INJURY, AND BALLISTIC INJURY, WERE DESCRIBED IN TERMS

OF THE ULTIMATE CLINICAL GOAL OF FUNCTIONAL AND COSMETIC RECONSTRUCTION(11)

THE PHYSIOLOGICAL AND PHYSICAL PRINCIPLES OF TREATING FACIAL INJURIES WERE

REVIEWED. A PROSPECTIVE CLINICAL STUDY BY S.J. KEYETAL OF 100 CONSECUTIVE

PATIENTS WITH FACIAL LACERATIONS REPAIRED BY AN ORAL SURGEON AND

MAXILLOFACIAL SURGEON WAS PERFORMED AND NUMEROUS LACERATIONS WERE

EXAMINED IN DETAIL . RESULTS WERE FIRST ASSESSED AT 1 WEEK AFTER SUTURE

REMOVAL,FOLLOWING INJURY. THE SPECIFIC PRACTICAL PROBLEMS ENCOUNTERED IN

REPAIRING SOFT TISSUE INJURIES WERE INVESTIGATED IN DETAIL USING HIGH-

MAGNIFICATION CLINICAL PHOTOGRAPHS TAKEN AFTER WOUND RESECTION,

IMMEDIATELY AFTER SUTURING, AND IMMEDIATELY FOLLOWING SUTURE REMOVAL.

ILLUSTRATED CASES WERE SELECTED BASED ON THE CHARACTERISTICS OF THE

LACERATIONS AND INCLUDED INCISED WOUNDS, SKIN LACERATIONS, SHELVING, AND

IRREGULAR WOUNDS IN ONE-THIRD OF THE UPPER, MIDDLE, AND LOWER S OF THE FACE.

IT WAS. THESE INCLUDED PERIORBITAL, NASAL .LABIAL, AND NECK INJURIES. HIGH

MAGNIFICATIONS SHOWED IRREGULARITY OF THE WOUND MARGIN IN ALMOST ALL CASES,

OFTEN SHOWED LOCAL ISCHEMIA, NECROSIS, LOCAL DEHISCENCE AND INFECTION, OR

INADEQUATE CLOSURE. THIS STUDY SUGGESTS THE NEED FOR A REASSESSMENT OF

TREATMENTS FOR FACIAL INJURIES, ESPECIALLY WITH RESPECT TO THE USE OF TOPICAL

SKIN MARGIN RESECTION, INFECTION PREVENTION, AND USE OF MAGNIFICATION DURING

CLOSURE(12).
E. OMOVIE ET AL. CONCLUDED IN A STUDY EVALUATING HEALING OF FACIAL INJURIES IN

100 LARGE (LESS THAN 30,000 NEW CASES PER YEAR) OF THE UK'S RANDOMLY SELECTED

EMERGENCY AND EMERGENCY DEPARTMENTS (AEDS) THAT AN IDEAL SUTURE FOR SKIN

CLOSURE WAS STILL UNAVAILABLE. THE SUTURES MUST BE EASY TO HANDLE AND ENABLE

EFFECTIVE WOUND CLOSURE. RELIABLE AND OPTIMAL ADHESION OF THE SKIN AND

WOUND EDGES MINIMIZES TISSUE REACTION AND HEALS PRIMARY WOUNDS, MINIMIZING

SCARRING, ESPECIALLY IN PREVENTING INFECTION. STUDIES SHOW THAT POLYBUTESTER

(NOVAFIL R) IS PREFERRED OVER POLYPROPYLENE. POLYBUTESTER DOES NOT EVEN FOLD IN

THE BAG WHILE POLYPROPYLENE DEFORMS CONTINUOUSLY. IT HAS BEEN FOUND THAT A

POLYBUTESTER KNOT REQUIRES LESS FORCE TO SLIP AND SECURE THAN A POLYPROPYLENE

KNOT. THE ELASTICITY OF THE POLYBUTESTER IS AN ADVANTAGE, BUT INITIALLY CAUSES

PROBLEMS WHEN TYING THE KNOTS. POLYGLACTIN 910 BRAIDED (VIKRYL R) IS

RECOMMENDED BY THE MANUFACTURER FOR REPAIRING SUBCUTANEOUS AND

MUSCULAR TISSUE. THE STUDY PRESENTED HERE17 INDICATES THAT MONOFILAMENT

POLYPAMIDE (ETHILON R) IS MOST COMMONLY USED TO CLOSE FACIAL INJURIES.(13)

S.R. MOBLEY ET AL. IN THE STUDY OF SURGICAL TISSUE ADHESIVE , DESCRIBED THE

MANUFACTURE, USE, AND BENEFITS OF FIBRIN TISSUE ADHESIVE AND CYANOACRYLATE.

THEY CONCLUDED THAT THESE BIOLOGICAL TISSUE ADHESIVES WERE SUCCESSFULLY USED

IN THE FIELD OF PLASTICS AND RECONSTRUCTIVE FACIAL SURGERY. CYANOACRYLATES

HAVE BEEN SHOWN TO PROVIDE HEMOSTASIS, OPTIMAL AESTHETIC AND EXCELLENT

TENSILE STRENGTH. CYANOACRYLATE AND FIBRIN-BASED GLUE SIMPLIFY FACIAL PLASTIC

SURGERY PRACTICES(14)
THE STUDY WAS CARRIED OUT BY MICHAEL J. BUCKLEY ET AL. PERFORMED TO

DETERMINE THE USE OF CYANOACRYLATE ADHESIVES IN ORAL AND MAXILLOFACIAL

SURGERY. THESE AUTHORS CONCLUDE THAT THE USE OF CYANOACRYLATE ADHESIVES

CAUSES REGULAR SKIN CLOSURES. CLOSURE OF DURAL LACERATIONS COMBINED WITH

DURAL CLOSURE HAS PROVEN TO BE VERY SUCCESSFUL. AS MORE HEAD AND NECK

RECONSTRUCTION AND COSMETIC PROCEDURES ARE DEVELOPED, THE DEMAND FOR

BETTER SURGICAL ADHESIVES WILL INCREASE. BONE FIXATION ADHESIVES, WHICH ARE

STILL IN THE EARLY STAGES OF DEVELOPMENT, ALSO SHOW A PROMISING CHEMICAL

PROFILE AND WILL BRING GREAT BENEFITS TO PATIENTS UNDERGOING ORAL AND

MAXILLOFACIAL SURGERY.(15)

JG K HANDSCHEL ET AL. A PROSPECTIVE STUDY WAS CONDUCTED TO COMPARE OCTYL2

CYANOACRYLATE AND SUTURES IN STANDARDIZED FACIAL WOUNDS. IN THIS STUDY, 45

OUT OF PATIENTS WITH SIMILAR FACIAL SCARS (INFRAORBITAL INCISIONS) WERE

TREATED. WOUND CLOSURE WITH SKIN ADHESIVE WAS USED IN 19 PATIENTS AND

MONOFILAMENT SUTURES WERE USED IN 26 PATIENTS. BASED ON THE EVALUATION OF

PATIENTS AND SURGEONS, THE AUTHORS CONCLUDED THAT SKIN ADHESIVES PROVIDE

A SAFER METHOD OF WOUND CLOSURE WITHOUT EARLY COMPLICATIONS. SEAM

WOUNDS HAVE HAD BETTER COSMETIC RESULTS, ESPECIALLY IN YOUNGER PATIENTS (16)

A RANDOMIZED CONTROLLED TRIAL WAS PUBLISHED BY A. MATTICK ET AL. PERFORMED

TO COMPARE TISSUE ADHESIVE (2 OCTYL CYANOACRYLATE) WITH ADHESIVE STRIPS

(STERISTRIPS) FOR THE REPAIR OF PEDIATRIC LESION. THE STUDY WAS CONDUCTED ON 60

CHILDREN WITH SUTAIBLE INJURIES BY TREATING 30 CHILDREN WITH TISSUE GLUE AND

30 CHILDREN WITH ADHESIVE STRIPS. USING A LINEAR VISUAL ANALOG SCALE, THE
AUTHOR FOUND THAT BOTH TISSUE ADHESIVES AND TAPES HAD SIMILAR EFFICACY,

PARENTAL ACCEPTABILITY, AND COSMETIC RESULTS FOR PROPER PEDIATRIC WOUND

CLOSURE. WE CONCLUDE THAT IT IS AN EXCELLENT NEEDLELESS ALTERNATIVE.

A prospective non-randomized study was published by Nanjappa Madan et al. Performed

to evaluate 2-octyl cyanoacrylate tissue adhesive as an acceptable alternative to suturing

head and neck incisions. The study included 24 patients divided into two groups, group 1

closed the incision with suture [mersilk 30] containing 13 patients, and group 2 15

patients. The incision was closed with 2 octyl cyanoacrylate containing. The authors

conclude that the effectiveness of and the benefits of relatively painless wound closure

provide excellent cosmetic results for . The rates of inflammation, dehiscence, and

infections are comparable to sutures. Tissue glue can be tried instead of sutures when

closing the head and neck incision. (18)

 METHODOLOGY

Patients in need of closure of head and neck skin wounds were selected for the study.

Patients who met all eligibility criteria were randomized to receive either topical

application of butyl l-2 cyanoacrylate or standard polypropylene wound closure . It

contained length lacerations ranging from 0.5 to 5 cm. In all cases, including , bilayer

closure of the subcutaneous tissue was performed with 3-0 Vicryl and 4-0 Prolene

sutures. Wounds requiring a surgical toilet were treated with debridement using hydrogen

peroxide, followed by wound cleansing with povidone iodine and saline prior to the

closure procedure.

In Group 1 the lacerations were closed with polypropylene cutting body by simple interrupted

suturing technique making sure that the wound edges were in close approximation to each other

during the closure. The sutures were removed after an interval of 7 days.

In Group 2 subjects were tested for acrylic allergy through intradermal patch test and were taken up

for further procedure only if the test was negative. Wound edges were approximated and

maintained in this position either with Adson forceps or manually with fingers. An ampule of 0.5ml

Cyanoacrylate was broken and solution was loaded in a 2ml syringe, gently liquid was expressed

through the needle and adhesive was applied in a thin layer along the edges of the incision. Three

repeated applications with an interval of fifteen seconds were required to achieve maximum tensile

strength across the wound edges.

Application of any sort of medication or associated dressing was not required since the adhesive

being water proof, bacteriostatic and hemostatic acts as a protective dressing. It took as long as 5

minutes for the cyanoacrylate polymer to dry completely.

Post operatively wounds were evaluated on the immediate post-operative, 7th and 24th post-

operative days for infection, dehiscence, pain, inflammation and esthetic outcome. Pain was

evaluated by using a visual analog scale ranging from 0 to 10 (0) being no pain and (10) being worst

pain possible. The pain was assessed by the patient in the immediate post-operative period. Time

taken was assessed in both the procedures individually from the start of the procedure to the

completion of wound closure. The time taken was noted by the operator.

The esthetic outcome was assessed using a previously validated 6-point scale. Lacerations were

assigned 0 or 1 point each for the presence or absence of the following: a step-off of borders;

contour irregularities; excessive wound distortion; wound margin separation; wound edge inversion

and overall appearance. A total cosmetic score was then calculated by adding the individual scores

for the 6 categories. Wounds with a score of 6 was considered to have an optimal cosmetic

appearance. All other wounds were considered to have a suboptimal appearance. Pain was

evaluated by using a 9 point visual analogue scale(VAS) anchored by the verbal descriptors “no

pain”(0) and very “severe pain ”(8)

Time taken was evaluated as follows:

PROCEDURE TIME TAKEN IN SECS/MINS

CYANOACRYLATE TISSUE ADHESIVE

POLYPROPYLENE SUTURING
MATERIALS AND METHOD

SOURCE OF DATA:

Type of study: Prospective study

Study of Population: Patients reporting to the Department of Oral and Maxillofacial

Surgery at CHANDRA DENTAL COLLEGE AND

HOSPITAL,SAFEDABAD,BARABANKI.

METHODS OF COLLECTION OF DATA

Sample size: A total number of 50 subjects, with lacerations of head and neck region in the

age group of 15-40 years were included in the study. These subjects were randomly divided

into two groups:

Group I : Lacerations closed using polypropylene

Group II : Lacerations closed using cyanoacrylates

Duration of the study: 2021 TO 2023

Criteria for selection of subjects:

Inclusion criteria

• Subjects requiring closure of the skin wounds in the head and neck region.
• Subjects between the ages of 15-40 yrs 40

• Subjects with wounds less than 6hrs of duration.

• Subjects in good health (ASA classification 1 or 2)

• Subjects ready to sign informed consent

• A clean, non-gaping and uncontaminated wound.

Exclusion Criteria

• Subjects under ASA classification 3 or greater.

• Subjects with known history of hypertrophic scar.

• Subjects allergic to acrylic

. • Subjects with medical conditions affecting the wound healing like diabetes and

immunocompromised conditions.

• Lack of informed consent.

• Grossly contaminated wound.

 CASE HISTORY

FOR DISSERTION ENTITLED - A COMPARATIVE CLINICAL EVALUATION OF

EFFICACY OF SKIN ADHESIVE GLUE (2-METHYL -2-CYANOPROPIONATE OR
CYANOACRYLATE) VERSUS CONVENTIONAL SKIN SUTURING BY SUTURE
MATERIAL IN CLEAN SURGICAL AREAS

PATIENT NAME-

AGE/SEX- OPD NO.-

OCCUPATION- CONTACT NO. –

ADDRESS-

CHIEF COMPLAINT-

HISTORY OF PRESENT ILLNESS-

MEDICAL HISTORY-

PAST DENTAL HISTORY-

FAMILY HISTORY-

PERSONAL HISTORY-

MARRIED / UNMARRIED-

VEG/ NON-VEG-

OTHER HABITS- SMOKER / ALCOHOLIC /PAN MASALA/ TOBACCO CHEWING

ANY OTHER PARANORMAL HABITS-

BRUXISM-

EXAMINATION

GENERAL (SYSTEMIC) –

PULSE- TEMPERATURE-

B.P- RESPIRATORY RATE-

PALLOR- CYANOSIS-

ICTERUS- EYE REFLEXES-

CVS- CNS-

RESPIRATORY RATE- GASTRO-INTESTINAL SYSTEM

EXTRA-ORAL

FACIAL SYMMETRY-

TMJ-

LYMPH NODES-

INTRA-ORAL

MOUTH OPENING (mm)-

ORAL HYGIENE-

SOFT TISSUE EXAMINATION

GINGIVA-

MUCOUS MEMBRANE-

TONGUE / PALATE-

FAUCES TONSILS /UVULA-

HARD TISSUE EXAMINATION

OCCLUSION-

CARIOUS TOOTH-
GROSSLY CARIOUS TOOTH-

PERIODONTAL DISEASE/ STATUS-

MOBILITY-

TEETH PRESSENT –

REASON OF TOOTH LOSS & DURATION-

GINGIVAL WIDTH-

INVESTIGATIONS

RADIOLOGICAL FINDINGS

DISTANCE FROM THE CREST OF THE RIDGE-

i MAXILLARY SINUS

ii NASAL FLOOR

iii INFERIOR ALVEOLAR CANAL –

ADJACENT TOOTH -

CONDITION OF BONE-

INTRA-OPERATIVE-

POST – OPERATIVE-

IOPAR-

OPG-

BLOOD SUGAR-

RANDOM- FASTING-

TLC- PP-

PMN’S- BASO-

LYMPH NODE- MONO-

HB gm %- EOSINO-
ESR- ASO TITRE-

CT- BT-

ELISA- SERUM Na+, K+ -

HIV-I & HIV-II AUSTRALIAN ANTIGEN-

PRE-OPERATIVE ASSESSMENT –

TREATMENT PLAN-

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

CHANDRA DENTAL COLLEGE AND HOSITAL, SAFEDABAD,

BARABANKI
 INFORMED CONSENT

A COMPARATIVE CLINICAL EVALUATION OF EFFICACY OF TISSUE ADHESIVE

GLUE (n-BUTYL- CYANOACRYLATE) VERSUS CONVENTIONAL SKIN SUTURE
IN CLEAN SURGICAL INCISIONS

I, ........................................................................AGED............YEARS,SON/DAUGHTER

OF ..........................................................................HEREBY AUTHORIZE CHANDRA DENTAL

COLLEGE AND HOSPITAL, TO PERFOR ANY DIAGNOSTIC EXAMINATION AND SURGICAL

PROCEDURE.

ALL THE RISK FACTOR ASSOCIATED WITH DENTAL / ORAL & MAXILLOFACIAL

GENERAL/LOCAL ANESTHESIA / TACHEOSTOMY HAVE BEEN EXPLAINED TO ME. I AM READY

TO FACE ANY COMPLICATION, IF IT OCCURS DURING OR AFTER SURGERY.

THE ABOVE TRATMENT IS BEING CARRIED OUT WITH MY FULL CONSENT AND APPROVAL. I

WILL NOT INITIATE ANY LEGAL / CRIMINAL CASE AGAINST THE INSTITUTION AS WELL AS

DOCOR PARAMEDIAL STAFF FOR THE ABOVE TREATMENT.

PATIENT’S SIGNATURE NAME OF THE PG STUDENT

........................................... ..............................................

PATIENT’S WITNESS SIGNATURE SIGNATURE OF FACUTY MEMBER

............................................... ..................................................
REFERENCES

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2- Miriam Byrne, MD, FRCS (Plast), Al Aly, MD, FACS, The Surgical
Suture, Aesthetic Surgery Journal, Volume 39, Issue Supplement_2, April 2019, Pages
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THOMAS B. BRUNS, M.D., AND J. MACK WORTHINGTON, M.D

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12-1.S.J. Key, D.W Thomas, J.P. Shepherd. The management of soft tissue facial wounds. British
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14-Mobley S.R, Hilinski J, Toriumi D.M. Surgical tissue adhesives. Facial Plast Surg Clin N Am
2002;10:147–154

15-M.J. Buckley, E.J. Beckman. Adhesive Use in Oral and Maxillofacial Surgery. Oral Maxillofacial Surg
Clin N Am 2010;22:195–199.

16-.J. G. K. Handschel, R. A. Depprich, D. Dirksen, C. Runte, A. Zimmermann, N. R. Kubler: A

prospective comparison of octyl-2-cyanoacrylate and suture 81 in standardized facial wounds. Int. J.
Oral Maxillofac. Surg. 2006; 35: 318– 323.

17-.A Mattick, G Clegg, T Beattie, T Ahmad. A randomised, controlled trial comparing a tissue
adhesive (2-octylcyanoacrylate) with adhesive strips (Steristrips) for paediatric laceration repair.
Emerg Med J 2002;19: 405-407

18- Madan N, Kumaraswamy S.V, Ashoka, Keerthi R, Ashwin D.P. Evaluation of 2- octyl cyanoacrylate
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2010;2(3):33-39.