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Adhesives Instead of Stitches Reduces Scarring With Less Pain

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If you have a facial cut in the future, you may not need to see a doctor for sewing.  Instead, you may see the nurse for gluing. 

During my years as an emergency room doctor, I saw a lot of facial lacerations, especially in children.  In fact, during the winter months, in the days before face shields were attached to helmets, it seemed that I did nothing but sew up kids hockey teams.  If I sewed up three six year olds in yellow uniforms, and then three in red uniforms, it was a safe bet that the game had ended in a tie.  Well, now, children's lacerations may not end in a tie at all, but rather in a gluing.  Dr. David Watson, a specialist in accident and emergency medicine in Mayday Hospital London, reported his findings in the British Medical Journal (Oct.21, 1989).  He studied fifty children under the age of forteen years, who had superficial lacerations.  These were treated with cyano-acrylate tissue glue, known as Histoacryl, and then they were followed up with photographs and repeat visits.  The glue was essentially painless to apply, although some noted a sting less than a second in duration.  The results showed fantastic healing, with none of the cross-hatching or pigmented dots that can accompany sutures.  Besides faster heasling and less pain, another major benefit iis the time saved for all concerned.  Instead of waiting for the doctor, kids with minor cuts can be glued by the nurse.  Instead of returning to have the sutures removed, they just carry on. 

Natural Goo

The search for adhesives that can perform better than sutures and surgical staples has recently been taking researchers into some unexpected places. There are a number of organisms that produce natural adhesives that could make stitches a thing of the past. Take slugs, for instance.

Andrew Smith, a professor from New York's Ithaca College, worked with undergraduate students to capture slugs and "milk" them to collect a defensive goo that the animals use to protect themselves in the wild. Upon analyzing the secretions, Smith and his helpers found that it was formed out of a combination of metal ions and a network of polymers that was neither completely solid nor completely fluid. 
"Gel like this would make an ideal medical adhesive," Smith said. "It would stick to wet surfaces, and no matter how much the tissue flexed and bent, the gel would flex and bend with it. There would be no leakage or scarring."

Smith isn't the only scientist looking for a new glue in nature: German researchers are investigating the Asparagus beetle that uses a biological adhesive to attach its eggs onto asparagus spears, while a University of Utah professor is looking at the natural glue produced by caddisflies.

Medical glues are not new. They have been used for decades in Canada, Europe, Israel and the Far East. But doctors in the US paid little attention to them until the last year or so because the older glues had many limitations.

For one thing, they were too weak for all but small, shallow wounds. In addition, some caused toxic reactions on the skin. Perhaps the biggest strike against them was a finding published a decade ago that one adhesive induced cancer in laboratory rats.

More recent research has not borne out the cancer link, and newer medical glues are stronger and, when used properly, not toxic, said Dr. James Quinn, an assistant professor at the University of Michigan Medical School in Ann Arbor who was the lead author of the new study. His success in using medical glues in Canada as an emergency room doctor touched off his interest in doing research on them.

His new study included 130 adults with 136 lacerations on the face, torso, arms and legs that were treated in the emergency room of Ottawa General Hospital in Canada. Half the wounds were closed with a medical glue, the other half with stitches. Deep wounds that normally require two layers of stitches were given stitches beneath the skin and then randomly assigned to be closed with either glue or stitches on the surface.

Certain wounds were excluded from the study because of the high risk of infection and other complications, including animal bites and scratches and puncture wounds.

The study found that the wounds in each group healed equally well when evaluated within the first few days or weeks and again after three months. But the glue had two big advantages over stitches. First of all, it closed the wounds in a quarter of the time: about 3.6 minutes compared with 12.4 minutes. And patients reported significantly less pain.

Further studies are still going on, but it seems that children with facial cuts will be spared the needles, and instead be treated painlessly with glue.  I wish they had it when I was a kid.

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