The Use of 2-Octyl Cyanoacrylate Skin Adhesive for Laceration Repair in the Emergency Department

Objectives: Surgical adhesives are a common Emergency Department (ED) wound closure method. Advantages include

ease of closure, speed of closure, and decreased or elimination of injectable anesthetics. We sought to evaluate the how a new formulation of 2-octyl cyanoacrylate (2OCA) would perform used for closure of lacerations on ED patients presenting with lacerationslooking at post-procedure bleeding, dehiscence, and infection.

Methods: we performed a prospective open-label observational case study in an urban ED. Inclusion criteria included greater than 5 years of age, candidate for use of a topical surgical skin adhesive. Exclusion criteria included known sensitivity to topical tissue adhesive products or degrading products, a history of keloid formation, hypotension, insulin dependent diabetes mellitus, blood/clotting disorders, peripheral vascular diseases, hypertrophy history, or active infection. Subjects were followed at 48 hours postprocedure, 5-10 days, and at 14 days following the ED visit.

Results: A total of 35 patients were enrolled and 36 lacerations were repaired with 2OCA. Mean age was 33.1 (7-78 IQR) years of age. Laceration mean length was 3cm. Pain scale range before application of the skin adhesive was 0 to 5 with mean of 1.97. Pain was decreased in 23% of patients, increased in 9%. Prior to discharge, adequate hemostasis and wound closure occurred in 97.2% and 97.2% percentage of patients respectively. 5-10 day hemostasis and wound closure in 93.5% and 83.8% of patients respectively. 14 day hemostasis and wound closure occurred in

100% of patients not lost to follow up.

Conclusion: This study demonstrates that 2OCA is a safe product in terms of wound closure/bleeding for simple laceration repair in the ED setting. Patient and proper wound selection, protection, and aftercare are important. 2OCA is a practical alternative to other common skin closure techniques available.