In recent years, many types of skin glue have appeared on the market for professional and consumer use. I’m often asked during the evaluation of a minor laceration if using glue is an viable option. While it’s a matter of opinion and personal preference of the clinician, there are many variables that can affect the success and cosmetic outcome of a injury repaired with skin glue. To understand these variables, we must first acknowledge that the wound is not actually “glued” together. In other words, you can’t actually apply the glue directly into the meat of the laceration. This is because the chemical in the glue is very irritating to the tissue and will actually dry and form a barrier to the healing tissue. Instead, the glue is applied to the skin surrounding the wound, forming a sort of traction bandage, or “chemical butterfly bandage,” thereby holding the wound together.
For this reason, the role of skin glues is limited to the superficial laceration in which the skin does not have much natural traction holding the wound apart. That means that bony prominences such as elbows, cheekbones, knuckles, and chins are not optimal places to use this technique. On the other hand, wounds that are located in areas with loose skin and naturally hold themselves closed, and are not across a joint, are more likely to have a successful closure and improved cosmetic outcome. These areas include the forehead, forearm, abdomen, inner thigh, and the fatty part of the cheek.
Keep in mind that when you close a laceration with glue, you are essentially forming a waterproof skin across the wound. Therefore if there is any chance of infection, the pus and extracellular fluids will have no place to escape to. For this reason, lacerations occurring from animal bites are not closed in this fashion. In addition, sweat, topical lotions, and especially oily substances, can cause the glue to lift off prematurely, allowing the laceration to reopen before it is healed.
To apply skin glue and effect a proper repair, start by cleaning and irrigating the wound. All foreign bodies and debris should be removed and then the wound should be re-irrigated. You should then hold pressure to the area until all bleeding has completely stopped as this dramatically affects the performance of the glue. Resist the temptation to continually remove the dressing to see if the bleeding has stopped. Just hold pressure and be patient. After the bleeding has completely stopped, you can manually apply traction to the surrounding skin to hold the wound closed. Then apply a strip of glue perpendicularly across the wound. Do not release your grip until the adhesive has dried or else glue will run into the laceration. Apply several coats to ensure strength and allow the glue to completely dry. The wound should hold itself closed at this point and you can test the range of motion of the injured body part to test the closure. Instructed the patient to keep the wound clean and dry, and your done!