Conclusion:
OCA effectively closed selected lacerations. It can replace the need for sutures in many lacerations.

STUDY

1. Prospective, randomized, controlled trial enrolled over 100 patients with lacerations.
2. Eligibility: all patients with lacerations requiring suture that were on the face, torso, or extremities, regardless of length or need for deep sutures. None were soiled or heavily contaminated, needing debridement.
3. Lacerations on mucosal surfaces, hands, feet, or crossing joints were excluded. Puncture wounds and stellate crush wounds were excluded.
4. Deep wounds were treated according the usual practice of the surgeon, including deep sutures. Only at the time of skin closure were patients randomized to skin sutures or OCA.
5. The edges of wounds to which OCA was applied were approximated. Physicians painted the OCA over the opposed wound edges with the applicator tip and were careful not to apply adhesive between the wound edges. (If OCA is applied in the deeper part of a wound, between the wound edges, it acts as a foreign body and as a barrier to wound healing.) The wound was held for 30 seconds to allow complete polymerization. No dressing is required.

RESULTS

1. The tissue adhesive was a faster method of wound repair (4 vs 12 min.).
2. Patients rated OCA as less painful than suturing.
3. There were no differences in a wound score which addressed 6 clinical variables, or in cosmetic outcomes.
4. There were 3 dehiscences in the OCA group and 1 in the suture group.

DISCUSSION

1. With minimal training, OCA can be incorporated into practice and produce cosmetic results similar to those of suturing while providing a fast and relatively painless closure.
2. Tissue adhesive wound repair is a manual skill like suturing, and requires careful application.
3. OCA can replace skin sutures on virtually all facial lacerations, and selected extremity and torso lacerations.
4. OCA should not be used on hands or over joints with repetitive movement.
5. Washing prematurely will peel off the adhesive before complete healing has taken place. Ordinarily the adhesive stays on for 7 to 14 days and sloughs off with the top layer of epidermis.
6. There is no need for follow up visits for suture removal.
7. Cost is relatively low.

CONCLUSION
OCA tissue adhesive effectively closed selected lacerations. It is fast and relatively painless. It can replace the need for suturing several million lacerations each year.
JAMA May 21, 1997; 277: 1527-30 Original investigation first author from Univ. Of Michigan, Ann Arbor.

Comment:
An editorial in this issue (pp 1559) comments: Cyano-acrylate tissue adhesives (CTA) have not yet been approved for marketing by the FDA. Approval is eagerly anticipated. In all probability, CTAs will change the care of selected, uncomplicated lacerations and incisions in important ways. In addition, they have been used for skin, bone, and cartilage grafting, corneal and eyelid surgery, endoscopic occlusion of gastrointestinal varices, embolic control of arteriovenous malformations, and repair of cerebrospinal fluid leaks. If traumatic wounds do not require extensive cleansing or sharp tissue debridement, local anesthesia is not required.
Great care has to be taken when handling CTAs because inadvertent spillage can cause unwanted adherence of uninvolved tissues, including those of the caregiver.